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Controlled Cortical Impact Model for Traumatic Brain Injury
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Multiple significant trauma with craniotomy: What impacts mortality?

Anand Dharia1, John Vincent Lacci1, Nikhil Gupte1

  • 1Long School of Medicine, University of Texas Health San Antonio, TX, USA.

Clinical Neurology and Neurosurgery
|September 28, 2019
PubMed
Summary

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In-hospital mortality for traumatic brain injury (TBI) patients with multiple traumas undergoing craniotomy is high, affecting one in three. Key risk factors for increased death include vasopressor use and status epilepticus.

Area of Science:

  • Trauma Critical Care
  • Neurosurgery
  • Epidemiology

Background:

  • Managing patients with traumatic brain injury (TBI) and multiple significant traumas is a critical challenge in trauma care.
  • Identifying risk factors through large databases can inform medical strategies and healthcare policies to improve patient outcomes.

Purpose of the Study:

  • To assess in-hospital mortality rates in patients undergoing craniotomy for multiple significant trauma in the United States.
  • To identify risk factors associated with increased mortality in this patient population.

Main Methods:

  • A retrospective cohort study utilizing the Nationwide Inpatient Sample (NIS) database.
  • Analysis of 26,650 patient discharges for "Craniotomy with Multiple Significant Trauma" between 2008-2016.
  • Multivariate logistic regression was employed to determine the impact of various factors on mortality.
Keywords:
CraniotomyMortalityMultiple significant traumaNationwide inpatient sampleSocioeconomic factorsTeaching hospitals

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Main Results:

  • Overall in-hospital mortality was 35.4%, with a slight increasing trend observed during the study period.
  • Factors significantly associated with higher mortality included vasopressor use (OR: 8.41), Status Epilepticus (OR: 3.33), self-pay status (OR: 4.81), private insurance (OR: 1.97), and discharge from urban teaching hospitals (OR: 1.4).

Conclusions:

  • Patients undergoing craniotomy for multiple traumas face a high mortality rate (approximately 33%), which has been increasing.
  • The need for vasopressors and the occurrence of Status Epilepticus are significant predictors of increased mortality, likely due to injury complexity.
  • Further clinical attention and research are warranted for this high-risk patient group.