Clinical profile of patients with acute traumatic brain injury undergoing cranial surgery in the United States : report from the 18-centre TRACK-TBI cohort study

Background: Contemporary surgical practices for traumatic brain injury (TBI) remain unclear. We describe the clinical profile of an 18-centre US TBI cohort with cranial surgery. Methods: The prospective, observational Transforming Research and Clinical Knowledge in Traumatic Brain Injury Study (2014...

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Autor: The TRACK-TBI Investigators
Tipo de recurso: artículo
Fecha de publicación:2024
País:España
Institución:Universidad Francisco de Vitoria
Repositorio:DDFV. Repositorio Institucional de la Universidad Francisco de Vitoria
Idioma:inglés
OAI Identifier:oai:ddfv.ufv.es:10641/7287
Acceso en línea:https://hdl.handle.net/10641/7287
Access Level:acceso abierto
Palabra clave:Craniotomy
Decompressive craniectomy
Glasgow outcome scale
Medical decisionmaking
Neuroimaging
Traumatic brain injury
Traumatic intracranial hemorrhage
Triage
Internal Medicine
Health Policy
Public Health, Environmental and Occupational Health
SDG 3 - Good Health and Well-being
Yes
yes
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spelling Clinical profile of patients with acute traumatic brain injury undergoing cranial surgery in the United States : report from the 18-centre TRACK-TBI cohort studyThe TRACK-TBI InvestigatorsCraniotomyDecompressive craniectomyGlasgow outcome scaleMedical decisionmakingNeuroimagingTraumatic brain injuryTraumatic intracranial hemorrhageTriageInternal MedicineHealth PolicyPublic Health, Environmental and Occupational HealthSDG 3 - Good Health and Well-beingYesyesBackground: Contemporary surgical practices for traumatic brain injury (TBI) remain unclear. We describe the clinical profile of an 18-centre US TBI cohort with cranial surgery. Methods: The prospective, observational Transforming Research and Clinical Knowledge in Traumatic Brain Injury Study (2014–2018; ClinicalTrials.gov #NCT02119182) enrolled subjects who presented to trauma centre and received head computed tomography within 24-h (h) post-TBI. We performed a secondary data analysis in subjects aged ≥17-years with hospitalisation. Clinical characteristics, surgery type/timing, hospital and six-month outcomes were reported. Findings: Of 2032 subjects (age: mean = 41.4-years, range = 17–89-years; male = 71% female = 29%), 260 underwent cranial surgery, comprising 65% decompressive craniectomy, 23% craniotomy, 12% other surgery. Subjects with surgery (vs. without surgery) presented with worse neurological injury (median Glasgow Coma Scale = 6 vs. 15; midline shift ≥5 mm: 48% vs. 2%; cisternal effacement: 61% vs. 4%; p < 0.0001). Median time-to-craniectomy/craniotomy was 1.8 h (interquartile range = 1.1–5.0 h), and 67% underwent intracranial pressure monitoring. Seventy-three percent of subjects with decompressive craniectomy and 58% of subjects with craniotomy had ≥3 intracranial lesion types. Decompressive craniectomy (vs. craniotomy) was associated with intracranial injury severity (median Rotterdam Score = 4 vs. 3, p < 0.0001), intensive care length of stay (median = 13 vs. 4-days, p = 0.0002), and six-month unfavourable outcome (62% vs. 30%; p = 0.0001). Earlier time-to-craniectomy was associated with intracranial injury severity. Interpretation: In a large representative cohort of patients hospitalised with TBI, surgical decision-making and time-to-surgery aligned with intracranial injury severity. Multifocal TBIs predominated in patients with cranial surgery. These findings summarise current TBI surgical practice across US trauma centres and provide the foundation for analyses in targeted subpopulations. Funding: National Institute of Neurological Disorders and Stroke; US Department of Defense; Neurosurgery Research and Education Foundation.Facultad de Ciencias Experimentales20242024-11-0120242024-11-01journal articlehttp://purl.org/coar/resource_type/c_6501info:eu-repo/semantics/articleapplication/pdfhttps://hdl.handle.net/10641/7287reponame:DDFV. Repositorio Institucional de la Universidad Francisco de Vitoriainstname:Universidad Francisco de VitoriaInglésengopen accesshttp://purl.org/coar/access_right/c_abf2http://creativecommons.org/licenses/by-nc-nd/4.0/info:eu-repo/semantics/openAccessoai:ddfv.ufv.es:10641/72872026-06-11T12:44:57Z
dc.title.none.fl_str_mv Clinical profile of patients with acute traumatic brain injury undergoing cranial surgery in the United States : report from the 18-centre TRACK-TBI cohort study
title Clinical profile of patients with acute traumatic brain injury undergoing cranial surgery in the United States : report from the 18-centre TRACK-TBI cohort study
spellingShingle Clinical profile of patients with acute traumatic brain injury undergoing cranial surgery in the United States : report from the 18-centre TRACK-TBI cohort study
The TRACK-TBI Investigators
Craniotomy
Decompressive craniectomy
Glasgow outcome scale
Medical decisionmaking
Neuroimaging
Traumatic brain injury
Traumatic intracranial hemorrhage
Triage
Internal Medicine
Health Policy
Public Health, Environmental and Occupational Health
SDG 3 - Good Health and Well-being
Yes
yes
title_short Clinical profile of patients with acute traumatic brain injury undergoing cranial surgery in the United States : report from the 18-centre TRACK-TBI cohort study
title_full Clinical profile of patients with acute traumatic brain injury undergoing cranial surgery in the United States : report from the 18-centre TRACK-TBI cohort study
title_fullStr Clinical profile of patients with acute traumatic brain injury undergoing cranial surgery in the United States : report from the 18-centre TRACK-TBI cohort study
title_full_unstemmed Clinical profile of patients with acute traumatic brain injury undergoing cranial surgery in the United States : report from the 18-centre TRACK-TBI cohort study
title_sort Clinical profile of patients with acute traumatic brain injury undergoing cranial surgery in the United States : report from the 18-centre TRACK-TBI cohort study
dc.creator.none.fl_str_mv The TRACK-TBI Investigators
author The TRACK-TBI Investigators
author_facet The TRACK-TBI Investigators
author_role author
dc.contributor.none.fl_str_mv Facultad de Ciencias Experimentales
dc.subject.none.fl_str_mv Craniotomy
Decompressive craniectomy
Glasgow outcome scale
Medical decisionmaking
Neuroimaging
Traumatic brain injury
Traumatic intracranial hemorrhage
Triage
Internal Medicine
Health Policy
Public Health, Environmental and Occupational Health
SDG 3 - Good Health and Well-being
Yes
yes
topic Craniotomy
Decompressive craniectomy
Glasgow outcome scale
Medical decisionmaking
Neuroimaging
Traumatic brain injury
Traumatic intracranial hemorrhage
Triage
Internal Medicine
Health Policy
Public Health, Environmental and Occupational Health
SDG 3 - Good Health and Well-being
Yes
yes
description Background: Contemporary surgical practices for traumatic brain injury (TBI) remain unclear. We describe the clinical profile of an 18-centre US TBI cohort with cranial surgery. Methods: The prospective, observational Transforming Research and Clinical Knowledge in Traumatic Brain Injury Study (2014–2018; ClinicalTrials.gov #NCT02119182) enrolled subjects who presented to trauma centre and received head computed tomography within 24-h (h) post-TBI. We performed a secondary data analysis in subjects aged ≥17-years with hospitalisation. Clinical characteristics, surgery type/timing, hospital and six-month outcomes were reported. Findings: Of 2032 subjects (age: mean = 41.4-years, range = 17–89-years; male = 71% female = 29%), 260 underwent cranial surgery, comprising 65% decompressive craniectomy, 23% craniotomy, 12% other surgery. Subjects with surgery (vs. without surgery) presented with worse neurological injury (median Glasgow Coma Scale = 6 vs. 15; midline shift ≥5 mm: 48% vs. 2%; cisternal effacement: 61% vs. 4%; p < 0.0001). Median time-to-craniectomy/craniotomy was 1.8 h (interquartile range = 1.1–5.0 h), and 67% underwent intracranial pressure monitoring. Seventy-three percent of subjects with decompressive craniectomy and 58% of subjects with craniotomy had ≥3 intracranial lesion types. Decompressive craniectomy (vs. craniotomy) was associated with intracranial injury severity (median Rotterdam Score = 4 vs. 3, p < 0.0001), intensive care length of stay (median = 13 vs. 4-days, p = 0.0002), and six-month unfavourable outcome (62% vs. 30%; p = 0.0001). Earlier time-to-craniectomy was associated with intracranial injury severity. Interpretation: In a large representative cohort of patients hospitalised with TBI, surgical decision-making and time-to-surgery aligned with intracranial injury severity. Multifocal TBIs predominated in patients with cranial surgery. These findings summarise current TBI surgical practice across US trauma centres and provide the foundation for analyses in targeted subpopulations. Funding: National Institute of Neurological Disorders and Stroke; US Department of Defense; Neurosurgery Research and Education Foundation.
publishDate 2024
dc.date.none.fl_str_mv 2024
2024-11-01
2024
2024-11-01
dc.type.none.fl_str_mv journal article
http://purl.org/coar/resource_type/c_6501
dc.type.openaire.fl_str_mv info:eu-repo/semantics/article
format article
dc.identifier.none.fl_str_mv https://hdl.handle.net/10641/7287
url https://hdl.handle.net/10641/7287
dc.language.none.fl_str_mv Inglés
eng
language_invalid_str_mv Inglés
language eng
dc.rights.none.fl_str_mv open access
http://purl.org/coar/access_right/c_abf2

http://creativecommons.org/licenses/by-nc-nd/4.0/
dc.rights.openaire.fl_str_mv info:eu-repo/semantics/openAccess
rights_invalid_str_mv open access
http://purl.org/coar/access_right/c_abf2

http://creativecommons.org/licenses/by-nc-nd/4.0/
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.source.none.fl_str_mv reponame:DDFV. Repositorio Institucional de la Universidad Francisco de Vitoria
instname:Universidad Francisco de Vitoria
instname_str Universidad Francisco de Vitoria
reponame_str DDFV. Repositorio Institucional de la Universidad Francisco de Vitoria
collection DDFV. Repositorio Institucional de la Universidad Francisco de Vitoria
repository.name.fl_str_mv
repository.mail.fl_str_mv
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