title: [Urgency of neurosurgical interventions for severe traumatic brain injury].
abstract: BACKGROUND
  The aim of this study was to assess whether the time interval between accident and neurosurgical intervention has an influence on functional neurological outcome and mortality in severe traumatic brain injury (sTBI) or whether the further clinical course has already been determined by the initial severity of the injury.
  
  
  METHODS
  Data were derived from the Trauma Registry of the German Society of Trauma Surgery. A total of 770 patients were identified who had undergone decompressive surgery, had an ISS ≥ 9 and for whom time of accident and start of surgery had been documented. To evaluate the possible influence of the time factor on outcome and mortality, these patients were subdivided into five groups according to time until decompression (I: < 2 h, II: 2-3 h, III: 3-6 h, IV: 6-24 h and V: > 24 h). Aside from mortality we analysed AIS, GCS, age and ISS in survivors and non-survivors.
  
  
  RESULTS
  Complete data were available for 770 patients with sTBI (AIS skull ≥3). The average age was 39.9 years and 71.6% were male. The average overall injury severity was reflected by an ISS score of 31.3 and the average AIS head score was 4.51. Of the 570 who underwent surgery in less than 6 h (groups 1-III), 33% died (188/570). Of the remaining 200 patients 40 died (20%). Mortality decreased throughout the groups (49 to 14%), as did the severity of the head injury (AIS 4.66 to 4.23); GCS on the other hand increased with the time between accident and surgery (5.9 to 8.8).
  
  
  CONCLUSIONS
  We could not substantiate that reducing the time between accident and neurosurgical decompression could decrease mortality. It rather seems that the initial magnitude of brain damage determines prognosis and outcome after sTBI. The interval between the appearance of neurological symptoms (e.g. anisocoria) and neurosurgical intervention plays an important role and should be kept as short as possible.
authors: Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Gießen und Marburg GmbH, Standort Marburg, Baldingerstraße 1, 35043 Marburg. kuehnec@med.uni-marburg.de
authors: C A
authors: CA
authors: Kühne
authors: C
authors: C
authors: Mand
authors: R
authors: R
authors: Lefering
authors: S
authors: S
authors: Lendemans
authors: S
authors: S
authors: Ruchholtz
references: Acta Neurochir Suppl. 2006;96:17-20
references: 16671415
references: J Neurosurg. 1991 Feb;74(2):212-8
references: 1988590
references: Swiss Med Wkly. 2008 May 3;138(19-20):281-5
references: 18491241
references: Unfallchirurg. 2000 Feb;103(2):122-31
references: 10763364
references: Chirurg. 2002 Feb;73(2):194-207; quiz 208-9
references: 11974485
references: Acta Neurochir Suppl. 2005;93:207-8
references: 15986757
references: J Trauma. 1990 Aug;30(8):933-40; discussion 940-1
references: 2117669
references: J Trauma. 2009 Jul;67(1):85-90
references: 19590314
references: J Trauma. 1995 Jul;39(1):36-42; discussion 42-3
references: 7636908
references: J Trauma. 1999 May;46(5):914-9
references: 10338412
references: Acta Neurochir (Wien). 1996;138(2):185-91
references: 8686543
references: Eur Surg Res. 2007;39(6):372-9
references: 17690556
references: J Neurosurg. 2009 Oct;111(4):683-7
references: 19326973
references: J Trauma. 1996 Jul;41(1):120-2
references: 8676403
references: Acta Neurochir Suppl. 2010;106:235-7
references: 19812956
references: Acta Neurochir Suppl. 2006;96:11-6
references: 16671414
references: J Am Coll Surg. 2008 Mar;206(3):432-8
references: 18308212
references: Ir Med J. 2009 Sep;102(8):255-7
references: 19873866
references: J Trauma. 1989 Sep;29(9):1193-201; discussion 1201-2
references: 2769804
references: Neurocrit Care. 2008;8(3):337-43
references: 18273711
references: J Trauma. 1997 Jan;42(1):7-10
references: 9003251
references: Acta Neurochir Suppl. 2005;95:281-5
references: 16463866
references: Arch Surg. 2008 Dec;143(12):1213-7; discussion 1217
references: 19075174
references: Chin Med J (Engl). 2008 Jun 20;121(12):1080-4
references: 18706221
references: Surg Neurol. 1983 Mar;19(3):216-31
references: 6836474
references: Acta Neurochir (Wien). 1997;139(11):1042-7; discussion 1047-8
references: 9442218
references: J Neurol Neurosurg Psychiatry. 2001 Aug;71(2):175-81
references: 11459888
references: J Trauma. 1990 Jun;30(6):733-6
references: 2352302
references: Injury. 2007 May;38(5):576-83
references: 17472793
references: Chirurg. 2009 Feb;80(2):153-62; quiz 163
references: 19212694
references: N Engl J Med. 1981 Jun 18;304(25):1511-8
references: 7231489
references: J Trauma. 2002 May;52(5):907-11
references: 11988658
references: Ann Surg. 2005 Sep;242(3):364-70; discussion 370-4
references: 16135922