Urgency of neurosurgical interventions for severe traumatic brain injury

• Published in: Der Unfallchirurg Vol. 116; no. 1; pp. 39 - 46
• Main Authors: Kühne, C A, Mand, C, Lefering, R, Lendemans, S, Ruchholtz, S
• Format: Journal Article
• Language: German
• Published: Germany 01-01-2013
• Subjects: Adult; Brain Injuries - mortality; Brain Injuries - surgery; Decompressive Craniectomy - mortality; Female; Germany - epidemiology; Humans; Male; Middle Aged; Prevalence; Risk Assessment; Risk Factors; Survival Analysis; Survival Rate; Time-to-Treatment - statistics & numerical data; Trauma Severity Indices; Treatment Outcome; Germany
• ISSN: 1433-044X
• DOI: 10.1007/s00113-011-2042-6

The aim of this study was to assess whether the time interval between accident and neurosurgical intervention has an influence on functional neurological outcome and mortality in severe traumatic brain injury (sTBI) or whether the further clinical course has already been determined by the initial severity of the injury.
Data were derived from the Trauma Registry of the German Society of Trauma Surgery. A total of 770 patients were identified who had undergone decompressive surgery, had an ISS ≥ 9 and for whom time of accident and start of surgery had been documented. To evaluate the possible influence of the time factor on outcome and mortality, these patients were subdivided into five groups according to time until decompression (I: < 2 h, II: 2-3 h, III: 3-6 h, IV: 6-24 h and V: > 24 h). Aside from mortality we analysed AIS, GCS, age and ISS in survivors and non-survivors.
Complete data were available for 770 patients with sTBI (AIS skull ≥3). The average age was 39.9 years and 71.6% were male. The average overall injury severity was reflected by an ISS score of 31.3 and the average AIS head score was 4.51. Of the 570 who underwent surgery in less than 6 h (groups 1-III), 33% died (188/570). Of the remaining 200 patients 40 died (20%). Mortality decreased throughout the groups (49 to 14%), as did the severity of the head injury (AIS 4.66 to 4.23); GCS on the other hand increased with the time between accident and surgery (5.9 to 8.8).
We could not substantiate that reducing the time between accident and neurosurgical decompression could decrease mortality. It rather seems that the initial magnitude of brain damage determines prognosis and outcome after sTBI. The interval between the appearance of neurological symptoms (e.g. anisocoria) and neurosurgical intervention plays an important role and should be kept as short as possible.