The Mercy Hospital of Pittsburgh
Trauma Services
Title: Guidelines for Urgent Notification of Neurosurgeon
Definition:
Please note these guidelines are only guidelines. Should you, of course, have
a patient who does not meet these guidelines but appears to be suffering from a
significant neurosurgical injury or insult, do not hesitate to contact the
neurosurgeon immediately. Likewise, in a patient who is awake, alert and
otherwise seems fine, but does seem to meet some of these criteria, please feel
free to use your clinical judgment in terms of notifying either the neurosurgeon
or neurologist.
Procedure:
Clinical examination specifications for immediate neurosurgical consultation
prior to obtaining a CT scan:
- Patient with obvious open head injury, with depressed skull fracture or
cerebral tissue obviously seen on initial exam
- Patient with Glasgow Coma Scale(GCS) of eight (8) or less
- Patient with obvious signs of transtentorial herniation, including one
pupil dilated larger than the other, and focal weakness on the opposite side
of the body, including decorticate or decerebrate posturing
CT scan findings requiring urgent neurosurgical notification:
- Depressed fracture involving fragments past the inner table of the skull
- Any significant epidural hematoma
- Any subdural hematoma with evidence of mass effect and shift
- Any shift or mass effect greater than five (5) mms, even without obvious
hematoma
Date Issued: 3/99