(Reaffirmed, November 2009)
(Approved by the AANS Board of Directors and the Congress of Neurological
Surgeons Executive Committee, February 2009.)
There is an emerging crisis in the availability of pediatric neurosurgical
emergency care in many regions of the country. This is driven by a shortage
of pediatric neurosurgeons, a societal expectation for care delivery by fellowship
trained pediatric neurosurgeons, and individual neurosurgeons' concerns regarding
heightened medico-legal exposure. This confluence of events places the pediatric
patient in need of emergency neurosurgical procedures at risk for excessive
delays in treatment leading to suboptimal outcomes.
Optimal pediatric neurosurgical emergency care is delivered when a board eligible
or board certified (BE/BC) neurosurgeon performs necessary lifesaving and stabilizing
neurosurgical interventions and procedures for a pediatric patient prior to
elective transfer to a pediatric hospital when that transfer will result in
a significant delay. Regional hospitals and trauma centers, children's hospitals,
and state legislatures should work collaboratively with their neurosurgeons
to develop the financial and capital infrastructure, medico-legal protections,
appropriate credentialing profiles, and efficient triage and transfer protocols
to insure emergent neurosurgical intervention is provided for the pediatric
patient at the earliest opportunity.
- All American Board of Neurological Surgery (ABNS) BE/BC neurosurgeons are
trained and certified to competently perform emergency pediatric neurosurgery,
and as such are not obligated to transfer pediatric patients to a fellowship-trained
pediatric neurosurgeon prior to the diagnosis and stabilization of the patient.
Many neurosurgeons may choose to electively transfer pediatric neurosurgery
patients to colleagues as their individual practices develop along certain
- Some members of society have developed the unreasonable expectation that
any neurosurgical procedure performed in a pediatric patient be done in a
children's hospital by a fellowship-trained pediatric neurosurgeon. There
are only approximately 150 fellowship-trained pediatric neurosurgeons in
the United States and it is impossible that all pediatric neurosurgical emergencies
can be covered by this small subspecialty. The medico-legal exposure created
by this societal expectation has led many neurosurgeons to electively quit
caring for pediatric neurosurgical patients.
- The decision process and technical skills required for emergency neurosurgical
intervention for the pediatric patient parallels that for the adult. Even
for the BE/BC neurosurgeon who no longer routinely practices neurosurgery
on the pediatric population, the slight risk theorized from the lack of recent
experience is overshadowed by the irreversible disability or mortality that
can result from increased delay in treatment resulting from a transfer.