title: Emergent operation for isolated severe traumatic brain injury: Does time matter?
abstract: BACKGROUND
  It remains unclear whether the timing of neurosurgical intervention impacts the outcome of patients with isolated severe traumatic brain injury (TBI). We hypothesized that a shorter time between emergency department (ED) admission to neurosurgical intervention would be associated with a significantly higher rate of patient survival.
  
  
  METHODS
  Our institutional trauma registry was queried for patients (2003-2013) who required an emergent neurosurgical intervention (craniotomy, craniectomy) for TBI within 300 minutes after the ED admission. We included patients with altered mental status upon presentation in the ED (Glasgow Coma Scale [GCS] score < 9). Patients with associated severe injuries (Abbreviated Injury Scale [AIS] score ≥ 2) in other body regions were excluded. In-hospital mortality of patients who underwent surgery in less than 200 minutes (early group) was compared with those who underwent surgery in 200 minutes or longer (late group) using univariate and multivariate analyses.
  
  
  RESULTS
  A total of 161 patients were identified during the study time frame. Head computed tomographic scan demonstrated subdural hematoma in 85.8%, subarachnoid hemorrhage in 55.5%, and equal numbers of epidural hematoma and intraparenchymal hemorrhage in 22.6%. Median time between ED admission and neurosurgical intervention was 133 minutes. In univariate analysis, a significantly lower in-hospital mortality rate was identified in the early group (34.5% vs. 59.1%, p = 0.03). After adjusting for clinically important covariates in a logistic regression model, early neurosurgical intervention was significantly associated with a higher odds of patient survival (odds ratio, 7.41; 95% confidence interval, 1.66-32.98; p = 0.009).
  
  
  CONCLUSIONS
  Our data suggest that the survival rate of isolated severe TBI patients who required an emergent neurosurgical intervention could be time dependent. These patients might benefit from expedited process (computed tomographic scan, neurosurgical consultation, etc.) to shorten the time to surgical intervention.
  
  
  METHODS
  Prognostic study, level IV.
authors: From the Divisions of Acute Care Surgery (K.M., K.I., S.S., D.S., A.M.S., G.A.M., E.R.B., L.L., D.D.), and Neurocritical Care and Stroke (G.Y.S.), University of Southern California, Los Angeles, California.
authors: Kazuhide
authors: K
authors: Matsushima
authors: Kenji
authors: K
authors: Inaba
authors: Stefano
authors: S
authors: Siboni
authors: Dimitra
authors: D
authors: Skiada
authors: Aaron M
authors: AM
authors: Strumwasser
authors: Gregory A
authors: GA
authors: Magee
authors: Gene Y
authors: GY
authors: Sung
authors: Elizabeth R
authors: ER
authors: Benjaminm
authors: Lydia
authors: L
authors: Lam
authors: Demetrios
authors: D
authors: Demetriades
mesh_terms: D000328:Adult; D000368:Aged; D001930:Brain Injuries / Q000000981:diagnostic imaging / Q000401:mortality* / Q000601:surgery*; D015331:Cohort Studies; D003399:Craniotomy / Q000379:methods; D004636:Emergency Service, Hospital; D004638:Emergency Treatment / Q000379:methods; D005260:Female; D015600:Glasgow Coma Scale; D017052:Hospital Mortality; D006801:Humans; D015601:Injury Severity Score; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D019635:Neurosurgical Procedures / Q000379:methods* / Q000401:mortality; D011237:Predictive Value of Tests; D011379:Prognosis; D011859:Radiography; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D015996:Survival Rate; D061665:Time-to-Treatment; D016896:Treatment Outcome; D055815:Young Adult