Emergent operation for isolated severe traumatic brain injury: Does time matter?

Area of Science:

• Neurosurgery
• Trauma Surgery
• Emergency Medicine

Background:

• The impact of surgical timing on outcomes for isolated severe traumatic brain injury (TBI) remains under investigation.
• A hypothesis posits that reduced time from emergency department (ED) admission to neurosurgical intervention correlates with increased patient survival rates.

Purpose of the Study:

• To determine if the time interval between ED admission and neurosurgical intervention influences survival in patients with isolated severe TBI.
• To evaluate the association between early versus late surgical intervention and in-hospital mortality rates.

Main Methods:

• A retrospective analysis of a trauma registry (2003-2013) identified patients with TBI requiring emergent neurosurgical intervention within 300 minutes of ED admission.
• Patients with a Glasgow Coma Scale (GCS) score < 9 and isolated severe TBI (Abbreviated Injury Scale [AIS] score < 2 in other regions) were included.
• In-hospital mortality was compared between an 'early' surgery group (intervention < 200 minutes) and a 'late' surgery group (intervention ≥ 200 minutes) using univariate and multivariate analyses.

Main Results:

• A total of 161 patients were analyzed, with common findings including subdural hematoma (85.8%) and subarachnoid hemorrhage (55.5%).
• The median time to neurosurgical intervention was 133 minutes.
• The early surgery group exhibited significantly lower in-hospital mortality (34.5% vs. 59.1%, p = 0.03). Multivariate analysis confirmed early intervention was associated with a 7.41-fold increased odds of survival (p = 0.009).

Conclusions:

• Survival rates in isolated severe TBI patients undergoing emergent neurosurgical intervention appear to be time-dependent.
• Expedited care pathways, encompassing computed tomographic (CT) scans and neurosurgical consultations, may enhance survival for these critical patients.