Early Neurosurgical Procedures Enhance Survival in Blunt Head Injury: Propensity Score Analysis

Jerris R. Hedges, Craig Newgard, Judith Veum-Stone, Nathan Selden, Annette L. Adams, Brian S. Diggs, Melanie Arthur, Richard Mullins

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Background: Studies of trauma systems have identified traumatic brain injury as a frequent cause of death or disability. Due to the heterogeneity of patient presentations, practice variations, and potential for secondary brain injury, the importance of early neurosurgical procedures upon survival remains controversial. Traditional observational outcome studies have been biased because injury severity and clinical prognosis are associated with use of such interventions. Objective: We used propensity analysis to investigate the clinical efficacy of early neurosurgical procedures in patients with traumatic brain injury. Methods: We analyzed a retrospectively identified cohort of 518 consecutive patients (ages 18-65 years) with blunt, traumatic brain injury (head Abbreviated Injury Scale score of ≥ 3) presenting to the emergency department of a Level-1 trauma center. The propensity for a neurosurgical procedure (i.e., craniotomy or ventriculostomy) in the first 24 h was determined (based upon demographic, clinical presentation, head computed tomography scan findings, intracranial pressure monitor use, and injury severity). Multivariate logistic regression models for survival were developed using both the propensity for a neurosurgical procedure and actual performance of the procedure. Results: The odds of in-hospital death were substantially less in those patients who received an early neurosurgical procedure (odds ratio [OR] 0.15; 95% confidence interval [CI] 0.05-0.41). The mortality benefit of early neurosurgical intervention persisted after exclusion of patients who died within the first 24 h (OR 0.13; 95% CI 0.04-0.48). Conclusions: Analysis of observational data after adjustment using the propensity score for a neurosurgical procedure in the first 24 h supports the association of early neurosurgical intervention and patient survival in the setting of significant blunt, traumatic brain injury. Transfer of at-risk head-injured patients to facilities with high-level neurosurgical capabilities seems warranted.

Original languageEnglish (US)
Pages (from-to)115-123
Number of pages9
JournalJournal of Emergency Medicine
Volume37
Issue number2
DOIs
StatePublished - Aug 2009

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Neurosurgical Procedures
Closed Head Injuries
Propensity Score
Survival
Wounds and Injuries
Logistic Models
Odds Ratio
Head
Abbreviated Injury Scale
Confidence Intervals
Ventriculostomy
Craniotomy
Trauma Centers
Intracranial Pressure
Craniocerebral Trauma
Brain Injuries
Observational Studies
Hospital Emergency Service
Cause of Death
Research Design

Keywords

  • blunt head injury
  • craniotomy
  • injury survival
  • intracranial pressure monitor
  • propensity score
  • trauma center
  • trauma outcomes

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Early Neurosurgical Procedures Enhance Survival in Blunt Head Injury : Propensity Score Analysis. / Hedges, Jerris R.; Newgard, Craig; Veum-Stone, Judith; Selden, Nathan; Adams, Annette L.; Diggs, Brian S.; Arthur, Melanie; Mullins, Richard.

In: Journal of Emergency Medicine, Vol. 37, No. 2, 08.2009, p. 115-123.

Research output: Contribution to journalArticle

Hedges, Jerris R. ; Newgard, Craig ; Veum-Stone, Judith ; Selden, Nathan ; Adams, Annette L. ; Diggs, Brian S. ; Arthur, Melanie ; Mullins, Richard. / Early Neurosurgical Procedures Enhance Survival in Blunt Head Injury : Propensity Score Analysis. In: Journal of Emergency Medicine. 2009 ; Vol. 37, No. 2. pp. 115-123.
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