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Midlevel practitioners can safely place intracranial pressure monitors
Pamela J Young1, William M Bowling
1Department of Trauma & Surgical Critical Care, Hurley Medical Center, Flint, Michigan 48503, USA.
The Journal of Trauma and Acute Care Surgery
|August 1, 2012
Summary
Midlevel practitioners (MLPs) can safely place intracranial pressure (ICP) monitors, showing similar major complication rates compared to neurosurgeons. This supports MLPs in extending neurosurgical coverage at trauma centers.
Area of Science:
- Neurosurgery
- Trauma Care
- Medical Practice
Background:
- Neurosurgical coverage is a significant challenge for many trauma centers.
- Midlevel practitioners (MLPs) can help extend neurosurgical coverage by sharing workload.
- This study aimed to compare complication rates for intracranial pressure (ICP) monitor placement between neurosurgeons and MLPs.
Purpose of the Study:
- To determine if complication rates for intracranial pressure (ICP) monitor placement are similar between neurosurgeons and MLPs.
- To evaluate the safety and efficacy of MLPs in performing ICP monitor insertions.
- To assess the impact of MLP involvement on patient outcomes in neurocritical care.
Main Methods:
- A noninferiority trial design was used.
- Data from ICP monitors placed between June 2005 and March 2010 at a Level I trauma center were analyzed.
- Complications were classified as major or minor, with a 5% absolute difference in major complications defined as acceptable.
Main Results:
- Of 92 ICP monitors analyzed, 22 were placed by neurosurgeons and 70 by MLPs.
- One major complication (cerebrospinal fluid leak) occurred in a monitor placed by an MLP (1.4% vs. 0% for neurosurgeons, p = 0.0128).
- The minor complication rate was higher for MLPs (5.7% vs. 0%), and placement during the third shift was associated with shorter monitoring times.
Conclusions:
- Intracranial pressure (ICP) monitors can be safely placed by midlevel practitioners.
- Major complication rates for ICP monitor placement by MLPs are not significantly different from those by neurosurgeons.
- MLPs are capable of extending neurosurgical coverage for ICP monitor placement without compromising patient safety.
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