Introduction: Outcomes after traumatic cranial injury requiring surgical intervention remain poor. We reviewed our experience with emergency craniotomies or craniectomies for traumatic injury to identify predictors of favorable outcome.
Methods: We retrospectively reviewed all patients undergoing emergency craniotomy or craniectomy for trauma between July 2008 and September 2010. Patient demographics, radiographic data, hospital course, and clinical outcomes information were obtained. Outcomes were dichotomized as favorable for Glasgow Outcome Scale (GOS) 4-5 and unfavorable for GOS 1-3. Univariate analyses were performed using chi-square tests for categorical variables and Mann-Whitney U test for continuous variables after demonstrating non-normality of data. Multivariable analysis was conducted using logistic regression.
Results: Of 181 patients, 148 (81.8%) were male. The mean age was 43.1 years (range: 1-95 years). Glasgow Coma Scale (GCS) scores on presentation to the emergency department ranged from 3-8 in 79 patients (44.6%), 9-12 in 27 patients (15.3%), and 13-15 in 71 patients (40.1%). Fifty-one patients (29%) achieved a favorable outcome at discharge. Independent predictors of unfavorable outcome on univariate analysis included older age; lower GCS on presentation; and presence of subdural hematoma, intraparenchymal hematoma, intraventricular hematoma, or midline shift. Epidural hematoma was associated with favorable outcome. On multivariable analysis, only age (OR 0.965 per year, 95% CI 0.945 - 0.986), GCS (OR 1.312 per point, 95% CI 1.190 - 1.447), and epidural hematoma (OR 3.363, 95% CI 1.301 - 8.691) remained significant.
Conclusions: In patients undergoing emergency craniectomy or craniotomy for traumatic cranial injury, younger age, higher GCS on admission, and epidural hematoma were associated with favorable GOS at discharge.
Patient Care: Knowledge of factors associated with favorable outcomes will aid in operative decisions as well as discussion with families regarding prognosis.
Learning Objectives: By the conclusion of this session, participants should be able to:
1) State the rate of favorable outcome as defined by the GOS in patients after surgery for traumatic cranial injury in this series
2) State independent predictors of favorable outcome in this series
3) State factors associated with favorable outcome on multivariable analysis in this series