Introduction: Traumatic brain injuries (TBI) are a significant cause of morbidity and mortality sometimes requiring neurosurgical intervention. We sought to describe the epidemiology of TBI-related neurosurgical intervention (NSI) in the United States.
Methods: Using the Nationwide Inpatient Sample (2002-2011), all patients admitted with TBI were isolated and patients undergoing specific neurosurgical interventions (NSI) were identified. The Abbreviated Injury Scale classified (AIS) into mild (AIS<=2), moderate (AIS=3), and severe (AIS>=4). NSI procedures examined included: intracranial pressure (ICP) monitor placement, craniectomy/craniotomy, cranioplasty, ventriculostomy, and ventricular shunt placement.
Results: Among 2,057,726 patients admitted for TBI, NSI occurred in 6.4%, of whom 73.1% were male and 79.8% had insurance coverage. Patients undergoing NSI were younger than non-NSI patients (mean age 40.4 (SE 0.52) vs. 53.5 (SE 0.46) years, p<0.001). Most patients undergoing NSI were treated at teaching hospitals (77.1%) and in urban centers (95.7%) (both p<0.001), and had moderate (50.5%) or severe (44.8%) TBI. Diagnostic and monitoring procedures accounted for 34.9% of all NSI, followed by craniotomy/craniectomy (32.4%), cranioplasty (27.9%), ventriculostomy (23.8%) and ventricular shunt procedures (7.3%). Firearm injuries most frequently required NSI (23.3%) compared with pedestrian-injuries (10.8%) and motorcycle injuries (10.4%) (p<0.001). The proportion of TBI cases involving NSI decreased from 6.9% in 2002 to 5.2% in 2011 (p<0.001). Intracranial Pressure (ICP) monitors were placed in 0.44% of patients in 2007 vs. 1.47% in 2011 while the proportion of patients undergoing craniectomy/craniotomy declined slightly from 2.03% in 2002 to 1.83% in 2011 (both p<0.001). On average, patients undergoing NSI were hospitalized longer than non-NSI patients [16.4days (95%CI 15.7; 17.0)] vs. [5.8days 95%CI 5.6; 5.9)].
Conclusions: Younger patients and those with more severe TBI were more likely to undergo NSI, with a substantial increase in ICP monitor placements and corresponding decline in craniectomies/craniotomies. Not surprisingly, patients undergoing NSI required substantially longer inpatient care.
Patient Care: This study describes neurosurgical intervention in the management of traumatic brain injury at the population level and identifies specific patient and injury characteristics associated with neurosurgical intervention, which may provide a baseline for future patient-centered research to improve outcomes.
Learning Objectives: By the conclusion of this session, participants should be able to:
1) To quantify the aspects of the neurosurgical management of traumatic brain injury in the United States.
2) To describe current trends and changes in neurosurgical interventions for traumatic brain injury.
3) To identify patient and injury level factors associated with neurosurgical intervention in patients with traumatic brain injury.