The trauma-surgery interval--implications for the outcome of traumatic intracranial hematomas

The time that elapses between trauma and the beginning of surgical treatment is the interval during which traumatic intracranial hematomas are clinically manifested and diagnosed and the patients are prepared for surgical treatment. This trauma-surgery interval is divided into two periods: a diagnostic period and a period of preparation for surgery. A total of 610 patients treated in the Neurosurgery Department of the Plovdiv University of Medicine between 1975 and 1990 were retrospectively studied. They are allocated into groups of patients who survived or died during the trauma-surgery interval and patients treated during the consecutive stages of diagnostic capabilities of the Department: 1975-1979, 1980-1981, and 1982-1990. The study suggests that utilization of all methods of making a diagnose results in early identification of the hematoma and shortening of the diagnostic period of the trauma-surgery interval. This enables surgeons to operate on patients with acute hematomas at the earliest possible time after the trauma, achieving better therapeutic results. In patients with chronic hematomas the shorter diagnostic period makes it possible to devote the relatively expanded part of the trauma-surgery interval for preoperative preparation during which some concomitant disorders can be treated. Thus the risks from general anesthesia and the operative interventions are reduced.