Related Experiment Video
Updated: Jul 16, 2025
Controlled Cortical Impact Model for Traumatic Brain Injury
Published on: August 5, 2014
Direct to Operating Room for Decompressive Craniotomy/Craniectomy in Patients With Traumatic Brain Injury
Jesse K Kelley1, Katie E Jaje, Chase W Smitterberg
1Department of General Surgery, Corewell Health, Grand Rapids, Michigan (Drs Kelley, Chapman, and Yang); Michigan State University College of Human Medicine, Grand Rapids (Ms Jaje and Messrs Smitterberg and Reed); and Trauma Research Institute, Corewell Health, Grand Rapids, Michigan (Messrs Pounders and Groseclose, Mss Krech and Fisk, and Drs Chapman and Yang).
Background:
Emergent decompressive craniotomy/craniectomy can be a lifesaving surgical intervention for select patients with traumatic brain injury. Prompt management is critical as early decompression can impact traumatic brain injury outcomes.
Objective:
This study aims to describe the feasibility and clinical impact of a new pathway for transporting patients with severe traumatic brain injury directly to the operating room from the trauma bay for decompressive craniotomy/craniectomy.
Methods:
This is a retrospective cohort preintervention and postintervention study of severe traumatic brain injury patients undergoing decompressive craniectomy/craniotomy at a Midwestern U.S. Level I trauma center between 2016 and 2022. In the new pathway, the in-house trauma surgeon takes the patient directly to the operating room with the neurosurgery advanced practice provider to drape and prepare the patient for surgery while the neurosurgeon is en route to the hospital.
Results:
A total of 44 patients were studied, five (5/44, 11.4%) of which were in the preintervention group and 39 (39/44, 88.6%) in the postintervention group. The median arrival-to-operating room time was shorter in the postintervention cohort (1.4 hr) than in the preintervention cohort (1.5 hr). In examining night shifts only, the preintervention cohort had shorter arrival-to-operating room times (1.2 hr) than the postintervention cohort (1.5 hr).
Conclusion:
The study demonstrated that the new pathway is feasible and expedites patient transport to the operating room while awaiting the arrival of the on-call neurosurgeon.
