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Updated: Jun 30, 2026
Controlled Cortical Impact Model for Traumatic Brain Injury
Published on: August 5, 2014
Timing of Craniotomy and Associated Outcomes in Severe Blunt Traumatic Brain Injury
Sanjan Kumar1, Ariel Hus, Yumna Indorewala
1Author Affiliations: University of Central Florida College of Medicine, Orlando, Florida (Mr Kumar); Kiran Patel College of Osteopathic Medicine, NOVA Southeastern University, Fort Lauderdale, Florida (Mr Hus and Mrs Indorewala); Indiana University School of Medicine, Indianapolis, Indiana (Ms Zagales); University of Hawaii John A Burns School of Medicine, Honolulu, Hawaii (Mr Nishida); University of Miami Miller School of Medicine, Miami, Florida (Mr Bundschu); NOVA Southeastern University, Fort Lauderdale, Florida (Mr Brown); Division of Trauma and Surgical Critical Care, Department of Surgery, Orlando Regional Medical Center, Orlando, Florida (Dr Elkbuli); and Department of Surgical Education, Orlando Regional Medical Center, Orlando, Florida (Dr Elkbuli).
Introduction/Rationale:
Traumatic brain injuries (TBIs) are a leading cause of death among adults, resulting in approximately 214,110 TBI-related hospitalizations and 69,473 TBI-related deaths in the United States. There remains some debate regarding the optimal timing of craniotomy particularly as it relates to the use of intracranial pressure (ICP) monitoring.
Objective:
Our study aims to determine the association of time to craniotomy intervention (≤6 or >6 hr), ICP monitoring, and trauma center level on patient outcomes in blunt, severe, non-subarachnoid TBI with skull fracture.
Methods:
This retrospective study utilized the American College of Surgeons-Trauma Quality Improvement Program (ACS-TQIP) database to examine adult trauma patients (age ≥18 years, Injury Severity Score ≥15) between 2017 and 2023. The study included patients with isolated, severe, blunt, non-subarachnoid hemorrhage TBIs (Glasgow Coma Scale ≤8, Abbreviated Injury Scale ≥2) measuring ≥8 mm. Outcomes of interest were stratified by trauma center level and whether they underwent ICP monitoring.
Results:
A total of 3,265 adult patients with isolated, blunt, severe, non-subarachnoid TBIs were included in this analysis. Patients who had ICP monitoring and received craniotomy within 6 hr had no significant difference in odds of mortality (aOR: 0.662, 95% CI: 0.326-1.345, p = .254). Patients who received craniotomy beyond 6 hr were 2.5 times more likely to be associated with in-hospital mortality (aOR: 2.54, 95% CI: 1.19-5.39, p = .016). ICP monitoring correlated with a 1.4-day longer intensive care unit length of stay (β = 1.40, 95% CI: 0.56-2.25, p = .001) and 2.0 fewer ventilator-free days (β = -1.95, 95% CI: -3.16 to -0.74, p = .002). ICP-monitored patients had 50% lower odds of discharge to home (aOR: 0.50, 95% CI: 0.30-0.82, p = .006).
Conclusion:
In patients with severe TBI, our findings indicate that late craniotomy had increased odds of in-hospital mortality, suggesting a benefit to craniotomy prior to 6 hr. ICP monitoring should be evaluated on a case-by-case basis in this patient population to ensure proper and effective use toward improving patient outcomes and overall prognosis.
