Outcome of patients with severe brain trauma who were treated either by neurosurgeons or by trauma surgeons

Abstract

In Central Europe, patients with severe traumatic brain injury (TBI) are frequently treated by trauma surgeons rather than neurosurgeons. The objective of this study was to compare outcomes of patients with TBI by trauma surgeons or neurosurgeons. This study is a retrospective analysis of prospectively collected data. Between January 2001 and December 2005, 10 centers enrolled 311 operatively treated patients with severe TBI and no significant other injuries into observational studies. Data on accident, treatment, and outcomes were collected. Using the Glasgow Outcome Scale, 1-year outcomes were classified as "favorable" (scores 5 and 4) or "unfavorable" (scores <4). Data from patients operated by trauma surgeons ("group T") were compared with those from patients operated by neurosurgeons ("group N") using univariate and multivariate statistics. The scores published by Hukkelhoven et al. were used to estimate expected rates of death and unfavorable outcomes. There were 191 patients in group N and 120 in group T. There were no significant differences regarding age, sex, and trauma mechanisms between the two groups. Patients from group N had significantly higher trauma severity. The observed versus expected hospital mortality ratio was 0.84 for group N and 0.97 for group T (p = 0.051). One-year outcome was better in group T (28% vs. 19% good recovery, 1.7% vs. 9.4% vegetative status; p = 0.017), whereas mortality was not different (43% in both groups). Multivariate analysis revealed that outcomes were influenced by age and severity of TBI, whereas surgical specialty and treatment factors had no effects. With respect to operatively treated patients with TBI, trauma surgeons and neurosurgeons achieve comparable results. II.