Resident UNC Chapel Hill Durham, North Carolina, United States
Disclosure(s):
Nicole A. Silva, MD: No financial relationships to disclose
Introduction:
Background: Severe traumatic brain injury (sTBI) is a pressing public health issue posing significant morbidity/mortality to afflicted patients. Intracranial hemorrhage evacuation/decompression for sTBI is one of the most common interventions performed by neurosurgeons. While the effect of time to surgery has been studied extensively as the primary factor for survival, long-term dispositional outcomes are not well-described in the literature.
Methods: We evaluated the National Trauma Database (NTDB/NTDS) between 2010-2019 with Glasgow Coma Score (GCS) of 8 and under and associated intracranial hemorrhage undergoing intracranial evacuation/decompression. We analyzed numerous characteristics including: demographics (age, sex, race, ethnicity, payment status), disposition, time to surgery, pupillary response, presence of midline shift (>5 mm), post-operative inpatient complications and comorbidities. Disposition included home discharge (considered the ideal outcome), discharge to home with home health services (HHS), short-term hospital/acute inpatient rehab (AIR), skilled nursing facility (SNF)/long-term care hospital (LTCH), and expired.
Results: 7310 patients were analyzed, with 69.6% being White and 11.2% being Black. Young Black and Hispanic patients suffered more sTBI events compared to their matched elders, whereas elderly white patients suffered more sTBI events compared to their matched younger counterparts. The most common disposition across ages was SNF/LTCH. Expiration risk increased with age, with septagenarians/octogenarians being 12.1-21x (p < 0.001) more likely to expire following a sTBI compared to their younger counterparts. Patients aged 18-29, were 1.7x more likely (p < 0.001) to be discharged with HHS. Minority race/ethnicity groups were less likely to be discharged to AIR.
Conclusion : Neurosurgical intervention for intracranial hemorrhage in sTBI is a lifesaving procedure, with long-term morbidity being variable. Utilizing the largest collection of trauma data within the United States, we present quantitative evidence from perspective of disposition. Understanding these factors can help surgeons discuss potential outcomes for patients, promote preventative care, and generate tangible conversations with patients’ family members.
