title: Impact of Early Decompressive Craniectomy Following Blunt Traumatic Brain Injury on Mortality: Propensity Matched Analysis.
abstract: BackgroundThe purpose of this study was to evaluate the impact of the early craniectomy on mortality.HypothesisEarly craniectomy within 4 hours of hospital arrival will reduce in-hospital mortality.MethodsData were retrieved from the National Trauma Data Bank data set (RDS_2007-RDS_2010). All craniectomies performed on patients with a blunt mechanism of head injury within 24 hours of admission were included in the study. In-hospital mortality was the main outcome of interest.ResultsA total of 942 patients qualified for the study. Overall, 669 patients (71%) underwent a craniectomy within 4 hours (early group), and 273 patients (29%) had a craniectomy performed between > 4 hours to 24 hours following hospital arrival (late group). Propensity matched analysis identified 268 pairs of patients in both groups. The mean standardized differences were < 10% after matching. There were no significant differences in mortality (odds ratio: 1.018; confidence interval [CI], 0.689-1.506;p= 1.00), absolute risk reduction (0.004; 95% CI, - 0.078 to 0.085;p= 1.00), and length of stay (LOS) between the groups (hazard ratio: 0.770; 95% CI, 0.56-1.059;p= 0.108).ConclusionNo differences were seen on in-hospital mortality and hospital LOS between patients operated within 4 hours versus patients operated between 4 and 24 hours of admission.
authors.affiliation: Department of Surgery, Division of Trauma, Surgical Critical Care & Neurocritical Care, Jersey Shore University Medical Center, Neptune City, New Jersey, United States.
authors.forename: Nasim
authors.initials: N
authors.lastname: Ahmed
mesh_terms: D000293:Adolescent; D000328:Adult; D000070642:Brain Injuries, Traumatic / Q000401:mortality / Q000601:surgery*; D056424:Decompressive Craniectomy / Q000379:methods*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D013997:Time Factors; D061665:Time-to-Treatment; D016896:Treatment Outcome; D055815:Young Adult