title: Temporal trends in surgical intervention for severe traumatic brain injury caused by extra-axial hemorrhage, 1995 to 2012.
abstract: BACKGROUND
  Surgical intervention for severe traumatic brain injury (TBI) caused by extra-axial hemorrhage has declined in recent decades. The effect of this change on patient outcomes is unknown.
  
  
  OBJECTIVE
  To determine the change over time in surgical intervention in this population and to assess changes in patient outcomes.
  
  
  METHODS
  In this retrospective cohort study, the Washington State Trauma Registry was queried from 1995 to 2012 for patients with extra-axial hemorrhage and head Abbreviated Injury Scale score of 3 to 5. Data were linked to the state-wide death registry to analyze long-term mortality. The primary outcome was inpatient mortality. Secondary outcomes included 6- and 12-month mortality and modified Functional Independence Measure at discharge. Multivariable analyses were completed for all outcomes.
  
  
  RESULTS
  A total of 22974 patients met inclusion criteria. Over the study period, surgical intervention for severe TBI declined from 36% to 7%. There was a decline in case fatality from 22% to 12%. In 2012, the relative risk of inpatient mortality was 23% lower compared with 1995 (adjusted mortality risk ratio, 0.77; 95% confidence interval, 0.63-0.94). Changes in 6- and 12-month adjusted mortality and modified Functional Independence Measure were not statistically significant.
  
  
  CONCLUSIONS
  The decline in surgical intervention for severe TBI caused by extra-axial hemorrhage in Washington State was ubiquitous across regional, demographic, and injury characteristic strata. There was concurrently a reduction in inpatient mortality in this population. Functional status and long-term mortality, however, have remained the same. Future studies are needed to better identify modifiable risk factors for improvement in functional status and long-term mortality in this population.
authors.affiliation: *Harborview Injury Prevention and Research Center, Seattle, Washington; ‡Departments of Surgery, ‖Pediatrics, and #Neurosurgery, Harborview Medical Center and University of Washington, Seattle, Washington; §Department of Surgery, University of Virginia Medical Center, Charlottesville, Virginia; ¶Washington State Department of Health, Olympia, Washington.
authors.forename: Katherine T
authors.initials: KT
authors.lastname: Flynn-OʼBrien
authors.forename: Vanessa J
authors.initials: VJ
authors.lastname: Fawcett
authors.forename: Zeynep A
authors.initials: ZA
authors.lastname: Nixon
authors.forename: Frederick P
authors.initials: FP
authors.lastname: Rivara
authors.forename: Giana H
authors.initials: GH
authors.lastname: Davidson
authors.forename: Randall M
authors.initials: RM
authors.lastname: Chesnut
authors.forename: Richard G
authors.initials: RG
authors.lastname: Ellenbogen
authors.forename: Monica S
authors.initials: MS
authors.lastname: Vavilala
authors.forename: Eileen M
authors.initials: EM
authors.lastname: Bulger
authors.forename: Ronald V
authors.initials: RV
authors.lastname: Maier
authors.forename: Saman
authors.initials: S
authors.lastname: Arbabi
mesh_terms: D000328:Adult; D000368:Aged; D001930:Brain Injuries / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D002543:Cerebral Hemorrhage / Q000150:complications / Q000401:mortality / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000706:statistics & numerical data / Q000639:trends*; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014861:Washington / Q000453:epidemiology; D055815:Young Adult