Abstract
BackgroundThe time from injury to surgery (TIS) is critical in the functional recovery of individuals with traumatic acute subdural hematoma (TASDH). However, only few studies have confirmed such notion.MethodsThe data of TASDH patients who were surgically treated in Chia-Yi Christian Hospital between January 2008 and December 2015 were collected. The significance of variables, including age, sex, traumatic mechanism, coma scale, midline shift on brain computed tomography (CT) scan, and TIS, in functional recovery was assessed using the student’s t-test, Mann-Whitney U test, chi-square test, univariate and multivariate models, and receiver operating characteristic (ROC) curve.ResultsA total of 37 patients achieved functional recovery (outcome scale score of 4 or 5) and 33 patients had poor recovery (outcome scale score of 1–3) after at least 1 year of follow-up. No significant difference was observed in terms of age, sex, coma scale score, traumatic mechanism, or midline shift on brain CT scan between the functional and poor recovery groups. TIS was found to be significantly shorter in the functional recovery group than in the poor recovery group (145.5 ± 27.0 vs. 181.9 ± 54.5 min, P-value = 0.002). TIS was a significant factor for functional outcomes in the univariate and multivariate regression models. The analysis of TIS with the ROC curve between these two groups showed that the threshold time for functional recovery in comatose patients and those with TASDH who were surgically treated was 2 h and 57.5 min.ConclusionsTIS is an important factor l for the functional recovery of comatose TASDH patients who underwent surgery.
Highlights
The time from injury to surgery (TIS) is critical in the functional recovery of individuals with traumatic acute subdural hematoma (TASDH)
In patients who were included in the study, the following data were extracted from the medical database of our hospital: age, sex, trauma mechanism, coma scale score, pupil size, and light reflex, midline shift on brain computed tomography (CT) scan, whether craniotomy or craniectomy and evacuation of acute subdural hematoma were performed, postoperative intracranial pressure (ICP) in the surgical intensive care unit, information about postoperative complications or reoperation, time of injury notification, arrival time at the emergency room of our hospital, time of surgery initiation, and surgical outcomes
The results revealed that Time from injury to surgery (TIS) was a significant factor for functional outcomes in both regression models
Summary
The time from injury to surgery (TIS) is critical in the functional recovery of individuals with traumatic acute subdural hematoma (TASDH). Only few studies have confirmed such notion. Traumatic acute subdural hematoma (TASDH) is one of the most devastating types of traumatic brain injury (TBI), with a mortality rate ranging from 30 to 70% [1,2,3,4]. An emergent operation is considered if a patient is in coma or meets the surgical indication for TASDH. In 1981, Seelig et al (1981) have reported that the mortality rate of TASDH can be reduced from 90 to 30% if the. Chen et al BMC Neurology (2020) 20:226 trauma and who did not regain consciousness before surgical intervention was examined
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