Incidence of emergency neurosurgical TBI procedures: a population-based study

Abstract

Background The rates of emergency neurosurgery in traumatic brain injury (TBI) patients vary between populations and trauma centers. In planning acute TBI treatment, knowledge about rates and incidence of emergency neurosurgery at the population level is of importance for organization and planning of specialized health care services. This study aimed to present incidence rates and patient characteristics for the most common TBI-related emergency neurosurgical procedures. Methods Oslo University Hospital is the only trauma center with neurosurgical services in Southeast Norway, which has a population of 3 million. We extracted prospectively collected registry data from the Oslo TBI Registry – Neurosurgery over a five-year period (2015–2019). Incidence was calculated in person-pears (crude) and age-adjusted for standard population. We conducted multivariate multivariable logistic regression models to assess variables associated with emergency neurosurgical procedures. Results A total of 2151 patients with pathological head CT scans were included. One or more emergency neurosurgical procedure was performed in 27% of patients. The crude incidence was 3.9/100,000 person-years. The age-adjusted incidences in the standard population for Europe and the world were 4.0/100,000 and 3.3/100,000, respectively. The most frequent emergency neurosurgical procedure was the insertion of an intracranial pressure monitor, followed by evacuation of the mass lesion. Male sex, road traffic accidents, severe injury (low Glasgow coma score) and CT characteristics such as midline shift and compressed/absent basal cisterns were significantly associated with an increased probability of emergency neurosurgery, while older age was associated with a decreased probability. Conclusions The incidence of emergency neurosurgery in the general population is low and reflects neurosurgery procedures performed in patients with severe injuries. Hence, emergency neurosurgery for TBIs should be centralized to major trauma centers.

Referrals to Early Specialized Rehabilitation after Traumatic Brain Injury during the Covid-19 Pandemic

“…In the multivariable model, strong positive factors in both groups were younger age, pre-injury ASA-score 1–2, severe TBI, severe disability due to TBI upon discharge, in line with a previous study ( 14 ). We cannot fully explain the variation regarding male sex, but contributing factors may be that in younger TBI patients, males are over-represented and males more often need emergency neurosurgery ( 29 , 30 ). Interestingly, we found a difference in favour of the group who received neurosurgical procedure with ICP-sensor insertion in the pandemic group, although the difference was not statistically significant.…”

Care pathways and factors associated with interhospital transfer to neurotrauma centers for patients with isolated moderate-to-severe traumatic brain injury: a population-based study from the Norwegian trauma registry

“…The Brain Trauma Foundation guidelines do not state an upper age limit for neurosurgical care [ 4 ]; however, studies have found advanced age to be associated with lower treatment intensity, and the incidence of emergency neurosurgery has been found to peak at age 75 [ 18 , 42 , 43 ]. Our study identified a rapid decrease in transfer probability at the same ages.…”

“…Thus, care should be taken to make inferences about atypical patients. Sixth, highly relevant information about neurosurgical interventions among patients who underwent transfer was unfortunately not available from the NTR but has been studied elsewhere [ 43 ]. Neurosurgical procedures are not performed outside NTCs in Norway.…”

Sub-symptom threshold aerobic exercise for patients with persisting post-concussion symptoms and exercise intolerance after mild traumatic brain injury – a study protocol with a nested feasibility study for a randomized controlled trial

“…The clinical trial will be carried out at the TBI outpatient clinic at the Department of Physical Medicine and Rehabilitation, Oslo University Hospital (OUH), the trauma referral centre in South-East Norway [ 28 ]. Patients are referred to the TBI outpatient clinic from the Emergency department, Neurosurgical department, and from general practitioners.…”