title: The Clinical Value of Intraoperative Mobile Computed Tomography in Managing High-Risk Surgical Patients with Traumatic Brain Injury-A Single Tertiary Trauma Center Experience.
abstract: OBJECTIVE
  A subset of surgically treated patients with traumatic brain injury (TBI) cannot be stabilized by initial surgery. Mobile computed tomography (CT) provides real-time information for diagnosis in these TBI surgically high-risk (TBI-SHR) patients. The objective of this study was to analyze a 5-year series of TBI-SHR patients to evaluate the impact of intraoperative mobile CT (imCT) on prognosis.
  
  
  METHODS
  Of 1017 surgically treated patients with TBI retrospectively reviewed over a 5-year period (2009-2013), 59 patients required second operations within 72 hours of their initial surgery because of progressive or delayed hematomas (TBI-SHR group). Their clinical, radiographic, and intraoperative findings were compared among 19 patients who received imCT versus 40 patients who received fixed-unit CT.
  
  
  RESULTS
  Our TBI-SHR group accounted for 5.8% of all surgically treated patients with TBI. The use of imCT led to a change in surgical plan in 56% of patients with TBI intraoperatively. Younger patients (≤55 years; P < 0.05) with multifocal hemorrhage on preoperative CT (P = 0.033) and with an intraoperative unexpected event such as intraoperative intracranial pressure >20 mm Hg or acute brain swelling after adequate decompression (P = 0.003 and 0.004, respectively) significantly benefited from imCT in the TBI-SHR group. imCT also provided a quicker diagnosis (P < 0.001), led to a trend toward shorter intensive care unit stays (P = 0.077), and was associated with better neurologic outcomes at discharge days (P = 0.044).
  
  
  CONCLUSIONS
  The use of imCT is associated with better neurologic outcomes at discharge days compared with the use of fixed-unit CT in TBI-SHR patients.
authors.affiliation: Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.
authors.forename: Ko-Ting
authors.initials: KT
authors.lastname: Chen
authors.affiliation: Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.
authors.forename: Shih-Tseng
authors.initials: ST
authors.lastname: Lee
authors.affiliation: Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan. Electronic address: woodie2@cgmh.org.tw.
authors.forename: Chieh-Tsai
authors.initials: CT
authors.lastname: Wu
mesh_terms: D000553:Ambulatory Care / Q000379:methods*; D000070642:Brain Injuries, Traumatic / Q000000981:diagnostic imaging* / Q000601:surgery; D005260:Female; D015600:Glasgow Coma Scale; D006407:Hematoma, Epidural, Cranial / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D007430:Intraoperative Care / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012086:Reoperation / Q000706:statistics & numerical data; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D014193:Trauma Centers; D016896:Treatment Outcome
keywords: Delayed hematoma; Mobile computed tomography; Traumatic brain injury