Temporal delays in patients with traumatic brain injury in need of urgent surgical evacuation: retrospective analysis of the emergency department of a non-level I trauma center

Abstract

Time to surgical hematoma evacuation is important in the treatment of traumatic extraduraland subdural hematomas. The goal of this study was to characterize the time performance of the emergency department in the treatment of traumatic brain injury (TBI) in need of urgent surgical evacuation.

This retrospective study analyzed all TBI patients in need of a urgent surgical evacuation between 2010 and 2016, presenting to the emergency department of a large non-university teaching hospital. Time intervals were calculated. Demographic data, neurological status and outcome data were collected, the effects of these variables on time delay and in-hospital mortality were studied.

Of 235 patients, 43 were included in this study (median age 52, 44.2% women). The median time from the emergency department (ED) to computed tomography scan (CT), the median time from the CT to the operating room (OR) and the median ED-to-OR time were 24 minutes (IQR 13.5-35.5 minutes), 40 minutes (IQR 29.5- 68 minutes) and 67 minutes (IQR 47-109 minutes), respectively. Patients brought in by their own medical intervention team had a shorter time interval between arrival at the ED and CT, but there was no difference in the CT-OR interval or ED-OR interval. Initial Glasgow Coma Scale score, age and time of arrival had no effect on the temporal delay between arrival, CT imaging and OR.

Mortality was higher in patients with lower GCSand in older patients. There was no correlation between faster neurosurgical decompression and mortality.

The time interval for getting patients from the ED to CT and the OR in this study were in line with earlier studies. Time delays seem longer in the elderly patients. There was no benefit in survival in patients who had an earlier decompression in our small retrospective analysis.