Treatment Trends and Inpatient Mortality in Isolated Severe Traumatic Brain Injury Using the National Trauma Data Bank

Abstract

Severe traumatic brain injury (TBI) remains a leading cause of morbidity and mortality. Despite recommendations from the Brain Trauma Foundation, there is wide variability in treatment paradigms for severe TBI. We aimed to elucidate the variability of treatment, particularly neurosurgical procedures and how it affects mortality. Adult patients (<65 years old) with a severe isolated TBI who were treated at an American College of Surgeons level I trauma center were identified in the National Trauma Data Bank for the years 2007-2016. International Classification of Diseases, Ninth Revision procedure codes were used to identify primary treatment approaches: intracranial pressure (ICP) monitoring and cranial surgery (craniotomy/craniectomy). Among 25,327 patients with severe isolated TBI, 14.0% underwent ICP and 18.0% underwent cranial surgery. ICP monitoring reduced the odds of mortality (odds ratio 0.89, 95% confidence interval [0.81, 0.98]), but not the extent of cranial surgery (odds ratio 0.71, 95% confidence interval [0.65, 0.77]). Brain Trauma Foundation guidelines recommend placement of an ICP monitor for severe TBI; however, only 14% of patients with isolated, severe TBI underwent ICP monitoring in 2007-2016. ICP monitoring and cranial surgery decrease the odds of inpatient mortality in patients with severe TBI.