Friday, January 08, 2010

Should hospitalists be in charge of patients admitted with intracranial hemorrhage?

It may be a moot point because, like it or not, hospitalists are increasingly being asked to admit and be the attending physician for these patients. According to an article in Today's Hospitalist the number of head bleeds considered “surgical” is shrinking:

"Neurosurgeons are stepping further and further back from this disease because there really is not a role for surgery in ICH," points out Dr. Josephson, director of the neurohospitalist program and assistant professor of neurology at UCSF. The exceptions are cerebellar hemorrhages and those hemorrhages that are close to the surface. "Probably less than between 5% and 10% of ICH patients need surgical intervention," he says.

The article offers opinions and links to primary sources on the medical management of such patients, particularly hypertension management. Included is a section on blood pressure management in ischemic stroke in which the guideline recommended cut off of 220/120 is advocated.

Concerning ICH the larger question is whether hospitalists should be managing them in the first place, either as attending physicians or under some vaguely defined comanagement arrangement. Hospitalists are increasingly being maneuvered into managing patients outside the scope of their training and experience. This may emerge as a liability issue for the field.

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