Introduction: Over the past decade, the rate of traumatic brain injury (TBI)-related emergency room visits in the United States has increased by nearly 70%, yet mortality in these cases has decreased by 7%. This improvement in outcome is largely due to the strides made in prehospital care, intensive care unit management, and the effectiveness of neurosurgical procedures, such as decompressive craniectomies. With the increased incidence of TBI, it is imperative to identify clinical factors predictive of patients who benefit from early mobilization of resources and operative treatment. Equally important is the identification of patients with good prognostic signs among patients receiving surgical intervention for TBI.
Methods: We conducted a retrospective chart review of 181 patients requiring craniectomies and craniotomies for decompression or evacuation of hemorrhage following TBI at a single Level 1 trauma center between 2008-2010. Demographic features and perioperative clinical characteristics of these patients were examined in relation to positive outcomes, defined as discharge to home, and negative outcomes, defined as in-hospital mortality or discharge to step-down medical facilities.
Results: Decreased Glasgow Coma Scale (GCS) on admission, increased age, and pre-operative coagulopathies were independent pre-operative predictors of poor outcome. Additionally, lower GCS on discharge, increased operative length, and increased length of hospital stay were identified as independent predictors of negative outcomes after surgery.
Conclusions: This work supports some of the current prognostic models in the literature as well as identifies additional clinical variables with predictive value of outcomes in the pre- and post-surgical setting.
Patient Care: The incidence of traumatic brain injury continues to increase and be a cause of significant morbidity and mortality in the United States. This research will help identify clinical and demographic factors predictive of patients who might benefit from early mobilization of resources and operative treatment. In addition, this work aims to identify factors which may contribute to a poor outcome following surgical intervention. This data will help us develop prognostic models as well as validate existing ones in order to guide our clinical and surgical management of TBI patients.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the importance of identifying prognostic signs in patients receiving surgical intervention for TBI, 2) Discuss in small groups pre-operative and post-operative demographic and clinical predictors of poor outcome, and 3) Identify effective ways in which these prognostic variables can be utilized in the acute clinical and surgical management of TBI.