Abstract TMP65: Endovascular and Surgical Treatment of Subarachnoid Hemorrhage Patients in Trauma Setting: Analysis from National Trauma Data Base (NTDB)

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Background: Traumatic subarachnoid hemorrhage (tSAH) occurs in up to 60% of patients with traumatic brain injury (TBI) and is associated with higher death and disability in TBI patients. Vascular injury in the form of aneurysms, dissections, and transections may require treatment to prevent further bleeding episodes. We aimed to compare endovascular treatment with surgical treatment in tSAH patients. Methods: tSAH and related endovascular and surgical procedures were identified by ICD-9-CM codes from the National Trauma Data Bank (NTDB), using data files from 2009 to 2010. NTDB represents one of the largest trauma databases and contains data from over 900 trauma centers across the United States. Surgical and endovascular treatment groups were compared by variables of patient demographics, initial injury severity score (ISS) and Glasgow Coma Scale (GCS) assessment in the emergency department (ED), hospital course, and treatment outcomes. Results: A total of 119 tSAH patients were identified who required treatment for intracranial vascular injury. Of these, 53% received endovascular treatment and 47% were treated surgically. No differences in demographic characteristics between these two groups were observed. The mean Injury Severity Score (ISS) [23(19-26) versus 15(12-18); P=0.03] and frequency of skull base fracture (30% versus 2%; P<.0001) were significantly higher in the endovascular treated group than in surgical group. Admission GCS scores were also significantly lower in the endovascular treated group (P=0.007). ICU days in the endovascular treatment group were significantly lower than in the surgical group [14(10-17) versus 16(13-17); P=0.04]. ICU days remained significantly lower in the endovascular group after adjusting for admission GCS, ISSAIS, skull base fracture, and other characteristics [0.4 (0.2-0.8); P=0.009]. Although the mean length of hospital stay was 3 days less in the endovascular group, this difference was not statistically significant. Conclusion: Despite more severe injury and lower admission GCS scores, patients who received endovascular treatment had lower ICU day requirement and similar discharge outcomes. Such observations support the preferential use of endovascular treatment in trauma settings.