H. Safdar1, S. Bhogadi1, T. Anand1, H. Hosseinpour1, A. Nelson1, K. El-Qawaqzeh1, A. Tang1, L. J. Magnotti1, M. Ditillo1, B. Joseph1 1University Of Arizona, Division Of Trauma, Critical Care, Burns, And Emergency Surgery, Tucson, AZ, USA
Introduction: Traumatic Brain Injury (TBI) remains one of the most common causes of death among trauma patients, and the great majority of traumatic brain injuries are managed nonoperatively. There is a paucity of recent data regarding the profile of TBI patients and their need for intervention. We aimed to describe the injury patterns, need for intervention and outcomes of TBI patients on a nationwide basis.
Methods: A 2017-2019 retrospective analysis of the ACS-TQIP. We included all adult (>18 years) TBI patients (Head AIS>1, other body regions AIS <3). Outcome measures were injury characteristics, need for intervention, and mortality among all TBI patients. Univariate analyses were performed to describe the differences in injury characteristics, need for intervention, and mortality among operatively and non-operatively managed patients.
Results: A total of 2,593,423 patients were identified, among which 677,761 were TBI patients. The mean age was 54 ± 21 years, 61% were male, 74% were white, and the median ISS was 6 [3-10]. Among all trauma patients, 0.1% presented with an open head injury, 9.6% with subdural hematoma, 0.8% with epidural hematoma. When stratified by type of management, 4,538 (0.7%) patients required craniectomy, and 673,223 (99.3%) were managed non-operatively. Compared to nonoperatively managed patients, craniectomy patients had lower median GCS (8 [3-15 vs 15 [14-15]; p<0.001), higher rates of subdural hematoma (74.2% vs 21.4%; p<0.001), epidural hematoma (15.6% vs 1.8%; p<0.001), subarachnoid hemorrhage (51.7% vs 17.6%; p<0.001), ICP monitor placement (21.6% vs 0.9%; p<0.001), and mortality (23.4% vs 4.5%; p<0.001%). The median time to craniectomy among operatively treated patients was 3.9 [2 – 20] hours.
Conclusion: This epidemiological study sheds light on the current state of traumatic brain injuries across the United States. TBI remains a major cause of hospital admissions among trauma patients. However, more than 99% of TBI patients were managed non-operatively. Near one quarter of patients undergoing craniectomy succumbed to death. Active surveillance is warranted while managing TBI patients requiring neurosurgery.