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  • Inpatient Natural History for Survivors of Hemicraniotomy after Head Trauma: An analysis of the California Office of Statewide Health Planning and Development (OSHPD) database

    Final Number:

    Brian R Hirshman MA; Brandon A McCutcheon MPP; Bob Carter; Clark C. Chen MD PhD; David Chang

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2014 Annual Meeting

    Introduction: Most patients who require hemicraniotomy for head trauma will require inpatient attention in the months and years after discharge.

    Methods: A retrospective analysis was performed on all patients who required hemicraniotomy for trauma in the California Office of Statewide Health Planning and Development (OSHPD) database between 2000 and 2002. The timing and primary ICD9 diagnosis for each subsequent hospitalization after the index admission was determined. Analysis was performed in Stata.

    Results: A total of 5,332 hemicraniotomy patients were identified of which 2,769 patients had more than one subsequent admission post injury (median 2, range 1-55). Twenty-two percent of patients required hospitalization within a month of initial discharge, of which 29% were planned. Fifty-seven percent required hospitalization within one year, of which 35% were planned. Eighty-nine percent of all patients required hospitalization within five years. In the first year post-injury, the most common causes of hospitalization were intracranial hemorrhage or deformity. Subsequently, hospitalizations for pneumonia, septicemia, pneumonitis, and “general symptoms” were most common. Mortality was highest during or after pulmonary or cardiac admissions. Similar patterns were observed after hemicraniotomy for epidural, subdural, and subarachnoid bleeds with or without fracture.

    Conclusions: There are predictable patterns of subsequent hospitalization after head trauma. Understanding common patterns of hospitalization, and the timeline in which they usually occur, will help providers counsel patients and their families.

    Patient Care: Patients and families are likely to be anxious when a patient is admitted. Understanding the frequency with which patients are hospitalized, as well as common causes of admission over time, will help providers counsel patients and their families.

    Learning Objectives: By the conclusion of this session, participants should be able to: 1) Identify how frequently patients are likely to be hospitalized post hemicraniotomy 2) Identify some of the most common causes of hospitalization following hemicraniotomy 3) Identify approximately when these hospitalizations are likely to occur


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