Survey of current neurotrauma treatment practice in Japan

The Japanese Society of Neurotraumatology announced guidelines for management of severe traumatic brain injury (TBI) in 2000. To evaluate subsequent implementation of these guidelines, we investigated current severe TBI practices in Japan.

A questionnaire regarding management of severe TBI was sent to each of the 384 Japanese Neurosurgical Society specialist training medical centers and answers were received by mail from 233 centers (60.7%).

Of the medical centers, 29% have neurosurgeons in their emergency department. Initial TBI treatment responsibility resided in the Departments of Neurosurgery in 34% of the medical centers, in the emergency department in 29%, and in 36% responsibility is assigned to both departments. Surgery was performed by neurosurgeons in 90% of the centers and postoperative management was assigned to neurosurgeons in 76%. Acute stage magnetic resonance imaging was done in 52% of the centers. An intracranial pressure sensor was inserted in 55%, and jugular venous oxygen saturation was measured in 21%. Hypothermia therapy was performed in 47%, positive normothermia therapy was administered in 76%, and barbiturate therapy was administered in 70%. Of the centers, 94% acknowledged the guidelines but only 72% of the centers implemented protocols that conformed to the guidelines.

Neurosurgeons in Japan are positively involved in management of severe TBI, but few medical centers monitor TBI patients. Many medical centers find it difficult to conform to the guidelines due to lack of neurosurgeons and equipment. These problems can be addressed by consolidation of neurosurgeons into centralized centers and improvement of the medical insurance system.