Introduction: Severe intracranial hemorrhage is often treated surgically with decompressive hemicraniectomy to relieve increased intracranial pressure and prevent fatal herniation. Early identification of patients who are most likely to require extreme surgical intervention would help in determining which patients require early intervention.
Methods: 2199 patients with acute traumatic intracranial hemorrhage were identified through our institution’s trauma registry between 2005 and 2013. Performance of decompressive hemicraniectomy was was used as a dependent variable in a logistic regression to evaluate what factors might identify patients requiring surgical intervention. Independent variables that were controlled for included sex, age, systolic blood pressure, international normalized ratio, blood alcohol level, anticoagulation status, anti-platelet status, Glasgow Coma Scale (GCS), and Injury Severity Score (ISS). All possible logistic regressions were run and assigned Akaike Information Criterion scores. The logistic regression with the lowest corrected Akaike Information Criterion was selected.
Results: Sex, international normalized ratio, blood alcohol level, and anti-platelet status were excluded from the best model. Age and GCS were found to have significant positive associations with performance of craniectomy, while systolic blood pressure, anticoagulation status, and ISS were found to have significant negative associations with performance of craniectomy.
Conclusions: This study provides evidence as to which factors have significant associations with future performance of decompressive hemicraniectomy. These factors assist in identification of patients who might require surgery, allowing for early intervention.
Patient Care: Decompressive hemicraniectomy is an extreme surgical intervention that is used in only severe cases of intracranial hemorrhage. By identifying which patients might require surgery as early as possible, we can improve patient outcomes by quickly addressing an expanding bleed and preventing fatal herniation and increases in intracranial pressure.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the importance of early identification of patients who require surgical intervention for traumatic intracranial hemorrhage. 2) Discuss, in small groups the role of surgical intervention and the factors that contribute to patients requiring hemicraniectomy. 3) Identify an effective treatment for traumatic intracranial hemorrhage and identify which factors help identify patients who might this treatment.