- Title
- Time to traumatic intracranial hematoma evacuation: contemporary standard and room for improvement
- Creator
- Merakis, Michael P.; Weaver, Natasha; Fischer, Angela; Balogh, Zsolt J.
- Relation
- European Journal of Trauma and Emergency Surgery Vol. 50, p. 2181-2189
- Publisher Link
- http://dx.doi.org/10.1007/s00068-024-02573-0
- Publisher
- Springer
- Resource Type
- journal article
- Date
- 2024
- Description
- Purpose: Traumatic intracranial hematoma (TICH) is a neurosurgical emergency with high mortality and morbidity. The time to operative decompression is a modifiable but inconsistently reported risk factor for TICH patients? outcomes. We aimed to provide contemporary time to evacuation data and long-term trends in timing of TICH evacuation in a trauma system. Methods: A 13-year retrospective cohort study ending in 2021 at a trauma system with one level-1 trauma center included all patients undergoing urgent craniotomy or craniectomy for evacuation of TICH. Demographics, injury severity and key timeframes of care were collected. Subgroups analyzed were polytrauma versus isolated head injury, direct admissions versus transfers and those who survived versus those who died. Linear regression of times from injury to operating room was performed. Results: Seventy-eight TICH patients (Age: 35 (22-56); 58 (74%) males; ISS: 25(25-41); AIS head: 5 (4-5); mortality: 21 (27%) patients) were identified. Initial GCS was 8 (3.25-14) which decreased to 3 (3-7) by arrival in the trauma center. There were 46 (59%) patients intubated prior to arrival. Median time from injury to operation was 4.88 (3.63-6.80) hours. Linear regression of injury to OR showed increasing times to operative intervention for direct admissions to the trauma center over the study period (p=0.04). There was no associated change in mortality or Glasgow outcome score over the same time. Conclusion: This contemporary data shows timing from injury to evacuation is approaching 5 hours. Over the 13-year study period the time to operative intervention significantly increased for direct admissions. This study will guide our institutions response to TICH presentations in the future. Other trauma systems should critically appraise their results with the same reporting standard.
- Subject
- level of evidence; study type: 3b; retrospective cohort study; Traumatic intracranial hematoma (TICH)
- Identifier
- http://hdl.handle.net/1959.13/1516867
- Identifier
- uon:57045
- Identifier
- ISSN:1863-9933
- Rights
- This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
- Language
- eng
- Full Text
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