Why mortality is still high with modern care of 613 evacuated mass lesions presented as severe head injuries 1999-2009.
Of 1,949 successive acute severe head injuries (SHI) over a period of 11 years 1999-2009, 613 (31.5%) underwent evacuation of mass lesions. Mortality at 3 months of evacuated mass (EM) lesions was higher over 10 years compared with that of non-EM lesions (it was overall 22%). The reduction of mortality was significantly less in EM compared with that for non-surgical cases (14.4-9.4% recently) and for the cases that were operated but not for mass evacuation (18.1-12.1%). A few explanations are: first, more SDH (60.5% of the EM recently compared with 45.9% in the first few years); second, more severe cases and older patients with co-morbidities were treated surgically; third, advances in prehospital care brought more severe patients to operative care - the rate of referrals decreased from 61.5% to 52.8% recently; fourth, part of the significant shortening of the injury to NT admission time (163-141 min) vanished owing to the parallel elongation of admission to operation time (95-100 min), thus, the threshold recommendation of 4 h to mass evacuation was achieved in only 52%; fifth, introducing decompressive craniectomy was not associated with outcome improvement.
Department of Neurosurgery, Rambam Medical Center, Haifa, Israel. llevi@rambam.health.gov.il
Leon
L
Levi
Joseph
J
Guilburd
Jean
J
Soustiel
Gill
G
Sviri
Marius
M
Constantinescu
Menashe
M
Zaaroor
D000328:Adult; D000367:Age Factors; D000368:Aged; D006259:Craniocerebral Trauma / Q000453:epidemiology / Q000401:mortality* / Q000601:surgery*; D056424:Decompressive Craniectomy / Q000379:methods*; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D007427:Intracranial Pressure / Q000502:physiology; D008297:Male; D008875:Middle Aged; D011681:Pupil Disorders / Q000209:etiology; D012189:Retrospective Studies; D013396:Suction / Q000379:methods*