Neurocritical Care Practice Among Surgical Intensivists

Neurocritical Care Practice Among Surgical Intensivists Introduction: Trauma surgeons manage patients with neurocritical care (NCC) diagnoses, including traumatic brain injury (TBI), spine injury, and postoperative issues. Training and practice in NCC are variably incorporated in Surgical Critical Care (SCC). In 2021, a NCC board certification opened but no reported data on this program from a surgical perspective exists. Methods: Demographic and NCC exam results for surgical intensivists was obtained from the American Board of Surgery (ABS). Also, an electronic survey regarding demographics, NCC practice, clinical scenarios, and opinions regarding the pursuit and utility of NCC certification was distributed to a cohort of SCC diplomats. Results: 209 individuals participated in the survey and were included for analysis. Majority identified as male (59%), White (76%), and were double-board certified in General Surgery and SCC (93%). Fifty-eight (28%) had obtained (n=30) or are pursuing (n=28) NCC certification and were included as the NCC cohort. Many significant practice differences and significant differences in comfort with NCC diseases existed between the NCC and SCC cohorts. Most of the NCC cohort believe their NCC skills have improved and 79% recommend pursuing NCC certification. ABS data showed 190 surgeons have taken the NCC exam. Most were part of the practice pathway, male (69%), and on median 8 years from SCC certification. Cumulative pass rate for surgeons was significantly lower (40%) versus the 73% overall pass rate for 2021 (p<0.01). Conclusions: While NCC is an essential part of SCC practice, NCC certification may benefit only a small cohort. All surgeons were comfortable managing trauma related neurological disorders. NCC diseases that showed increased comfort by the NCC cohort were infrequently managed by most surgical intensivists. Overall exam pass rates for surgeons are lower than for non-surgical NCC specialists, highlighting the need for additional NCC exposure in fellowship and post-graduate practice.