Abstract
Background The purpose of this study was to evaluate the impact of the early craniectomy on
mortality.
Hypothesis Early craniectomy within 4 hours of hospital arrival will reduce in-hospital mortality.
Methods Data were retrieved from the National Trauma Data Bank data set (RDS_2007-RDS_2010).
All craniectomies performed on patients with a blunt mechanism of head injury within
24 hours of admission were included in the study. In-hospital mortality was the main
outcome of interest.
Results A total of 942 patients qualified for the study. Overall, 669 patients (71%) underwent
a craniectomy within 4 hours (early group), and 273 patients (29%) had a craniectomy
performed between > 4 hours to 24 hours following hospital arrival (late group). Propensity
matched analysis identified 268 pairs of patients in both groups. The mean standardized
differences were < 10% after matching. There were no significant differences in mortality
(odds ratio: 1.018; confidence interval [CI], 0.689–1.506; p = 1.00), absolute risk reduction (0.004; 95% CI, − 0.078 to 0.085; p = 1.00), and length of stay (LOS) between the groups (hazard ratio: 0.770; 95% CI,
0.56–1.059; p = 0.108).
Conclusion No differences were seen on in-hospital mortality and hospital LOS between patients
operated within 4 hours versus patients operated between 4 and 24 hours of admission.
Keywords traumatic brain injury - craniectomy - mortality
