Download PDF
J Neurol Surg A Cent Eur Neurosurg 2020; 81(04): 297-301
DOI: 10.1055/s-0040-1701235
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Pulmonary Complications and Sepsis Following Severe Acute Subdural Hematoma in Patients Who Underwent Craniotomy versus Craniectomy: A Propensity Score Matched Analysis

Nasim Ahmed
1   Division of Trauma and Surgical Critical Care, Jersey Shore University Medical Center, Neptune, New Jersey, United States
,
Patricia Greenberg
2   Department of Research Administration, Jersey Shore University Medical Center, Neptune, New Jersey, United States
,
Seung Hoon Shin
1   Division of Trauma and Surgical Critical Care, Jersey Shore University Medical Center, Neptune, New Jersey, United States
› Author Affiliations
Further Information

Publication History

10 July 2019

01 November 2019

Publication Date:
03 March 2020 (online)

    Permissions and Reprints

Abstract

Background The purpose of the study was to evaluate the impact of craniotomy (CO) and decompressive craniectomy (DC) for evacuation of acute subdural hematoma (SDH) on pulmonary complications and sepsis.

Methods Study data were obtained from the National Trauma Data Bank (2007–2010). Only patients who met all of the following criteria were included in this analysis: sustained blunt injuries, presented with severe traumatic brain injury, sustained an associated SDH, presented with an initial Glasgow Coma Scale (GCS) score ≤ 8 and an Abbreviated Injury Scale score of head ≥ 3, and underwent a CO or DC within 4 hours of hospital arrival. Patient characteristics and outcomes were compared between CO and DC, the two procedural groups. The data were first compared between the two unmatched groups; then propensity score matching and a matched pairs analysis were performed.

Results From the total population of 2,370 patients, 1,852 (78%) of them underwent CO, and the remaining 518 (22%) underwent DC. Some differences were found between the CO and DC groups regarding age (mean [standard deviation (SD)]: 47.9 years [22.8] versus 39.6 years [20.1]; p < 0.001), sex (male: 70.1% versus 74.7%; p = 0.05), race (white: 77.4% versus 73.4%; p = 0.06), the injury mechanism (fall: 50.7% versus 33.2%; p < 0.001), Injury Severity Score (mean [SD]: 28.0 [9.3] versus 30.5 [10.0]; p < 0.001), and GCS score (median [interquartile range] 3 [3–5] versus 3 [3–4])). After the propensity score matching, no significant differences were found between the groups on the variables just listed (all p > 0.05). No significant differences were seen between the CO and DC groups in the incidences of these conditions: acute respiratory distress syndrome (ARDS) (12.0% versus 8.1%; p = 0.20), pneumonia (34.9% versus 37.6%; p = 0.60), pulmonary embolism (PE) (3.5% versus 1.6%; p = 0.30), and systemic sepsis (6.2% versus 8.1%; p = 0.5).

Conclusion Although most of the patients underwent CO for acute SDH, no significant differences were observed in the incidence of ARDS, pneumonia, PE, or systemic sepsis when compared with patients who underwent DC.

Keywords

severe traumatic brain injury - subdural hematoma - craniotomy/craniectomy - pulmonary complications

Note

This study was presented at 38th Annual Meeting of the Surgical Infection Society; April 22–25, 2018, Westlake Village, CA.


 

  • References

  • 1 Rincon F, Ghosh S, Dey S. , et al. Impact of acute lung injury and acute respiratory distress syndrome after traumatic brain injury in the United States. Neurosurgery 2012; 71 (04) 795-803
    CrossrefPubMedGoogle Scholar
  • 2 Pelosi P, Ferguson ND, Frutos-Vivar F. , et al; Ventila Study Group. Management and outcome of mechanically ventilated neurologic patients. Crit Care Med 2011; 39 (06) 1482-1492
    CrossrefPubMedGoogle Scholar
  • 3 Woratyla SP, Morgan AS, Mackay L, Bernstein B, Barba C. Factors associated with early onset pneumonia in the severely brain-injured patient. Conn Med 1995; 59 (11) 643-647
    PubMedGoogle Scholar
  • 4 Holland MC, Mackersie RC, Morabito D. , et al. The development of acute lung injury is associated with worse neurologic outcome in patients with severe traumatic brain injury. J Trauma 2003; 55 (01) 106-111
    CrossrefPubMedGoogle Scholar
  • 5 Ghosh S, Dey SK, Maltenfort M. , et al. Epidemiological trends of adult respiratory distress syndrome (ARDS) after traumatic brain injury in the United States. Paper presented at: American Academy of Neurology 64th Annual Meeting; April 21–28, 2012; New Orleans, LA
    PubMedGoogle Scholar
  • 6 Goldstein JN, Fazen LE, Wendell L. , et al. Risk of thromboembolism following acute intracerebral hemorrhage. Neurocrit Care 2009; 10 (01) 28-34
    CrossrefPubMedGoogle Scholar
  • 7 Cardozo Júnior LC, Silva RR. Sepsis in intensive care unit patients with traumatic brain injury: factors associated with higher mortality. Rev Bras Ter Intensiva 2014; 26 (02) 148-154
    PubMedGoogle Scholar
  • 8 Kalanithi P, Schubert RD, Lad SP, Harris OA, Boakye M. Hospital costs, incidence, and inhospital mortality rates of traumatic subdural hematoma in the United States. J Neurosurg 2011; 115 (05) 1013-1018
    PubMedGoogle Scholar
  • 9 Leitgeb J, Mauritz W, Brazinova A. , et al. Outcome after severe brain trauma due to acute subdural hematoma. J Neurosurg 2012; 117 (02) 324-333
    Google Scholar
  • 10 Seelig JM, Becker DP, Miller JD, Greenberg RP, Ward JD, Choi SC. Traumatic acute subdural hematoma: major mortality reduction in comatose patients treated within four hours. N Engl J Med 1981; 304 (25) 1511-1518
    CrossrefPubMedGoogle Scholar
  • 11 Tien HC, Jung V, Pinto R, Mainprize T, Scales DC, Rizoli SB. Reducing time-to-treatment decreases mortality of trauma patients with acute subdural hematoma. Ann Surg 2011; 253 (06) 1178-1183
    CrossrefPubMedGoogle Scholar
  • 12 Rush B, Rousseau J, Sekhon MS, Griesdale DE. Craniotomy vs craniectomy for acute traumatic subdural hematoma in the United States: a national retrospective cohort analysis. World Neurosurg 2016; 88: 25-31
    CrossrefPubMedGoogle Scholar
  • 13 van Essen TA, den Boogert HF, Cnossen MC. , et al. Variation in neurosurgical management of traumatic brain injury: a survey in 68 centers participating in the CENTER-TBI study. Acta Neurochir (Wien) 2019; 161 (03) 435-449
    CrossrefPubMedGoogle Scholar
  • 14 Hutchinson PJ, Kolias AG, Tajsic T. , et al. Consensus statement from the International Consensus Meeting on the Role of Decompressive Craniectomy in the Management of Traumatic Brain Injury: Consensus statement. Acta Neurochir (Wien) 2019; 161 (07) 1261-1274
    CrossrefPubMedGoogle Scholar
  • 15 Busl KM, Ouyang B, Boland TA, Pollandt S, Temes RE. Prolonged mechanical ventilation is associated with pulmonary complications, increased length of stay, and unfavorable discharge destination among patients with subdural hematoma. J Neurosurg Anesthesiol 2015; 27 (01) 31-36
    CrossrefPubMedGoogle Scholar
  • 16 Rosenbaum PR, Rubin DB. The central role of the propensity score in observational studies for causal effects. Biometrika 1983; 70 (01) 41-55
    CrossrefPubMedGoogle Scholar
  • 17 Ho DE, Imai K, King G, Stuart EA. MatchIt: Nonparametric preprocessing for parametric causal inference. J Stat Softw 2011; 42 (08) 1-28
    PubMedGoogle Scholar
  • 18 Hothorn T, Hornik K, van de Wiel MA, Zeileis A. Implementing a class of permutation tests: The coin package. J Stat Softw 2008; 28 (08) 1-23
    Google Scholar
  • 19 R Core Team. R: A language and environment for statistical computing. Vienna, Austria: R Foundation for Statistical Computing; Available at: http://www.R-project.org/ 2014. . Accessed October 2, 2015
    Google Scholar
  • 20 StataCorp. Stata Statistical Software: Release 13. College Station, TX: StataCorp LP; 2013
    Google Scholar
  • 21 Lim HB, Smith M. Systemic complications after head injury: a clinical review. Anaesthesia 2007; 62 (05) 474-482
    CrossrefPubMedGoogle Scholar
  • 22 Zygun DA, Kortbeek JB, Fick GH, Laupland KB, Doig CJ. Non-neurologic organ dysfunction in severe traumatic brain injury. Crit Care Med 2005; 33 (03) 654-660
    CrossrefPubMedGoogle Scholar
  • 23 Omar M, Moore L, Lauzier F. , et al. Complications following hospital admission for traumatic brain injury: A multicenter cohort study. J Crit Care 2017; 41: 1-8
    CrossrefPubMedGoogle Scholar
  • 24 Goyal K, Hazarika A, Khandelwal A. , et al. Non-neurological complications after traumatic brain injury: a prospective observational study. Indian J Crit Care Med 2018; 22 (09) 632-638
    CrossrefPubMedGoogle Scholar
  • 25 Selassie AW, Fakhry SM, Ford DW. Population-based study of the risk of in-hospital death after traumatic brain injury: the role of sepsis. J Trauma 2011; 71 (05) 1226-1234
    CrossrefPubMedGoogle Scholar
  • 26 Corral L, Javierre CF, Ventura JL, Marcos P, Herrero JI, Mañez R. Impact of non-neurological complications in severe traumatic brain injury outcome. Crit Care 2012; 16 (02) R44
    CrossrefPubMedGoogle Scholar
  • 27 Schirmer-Mikalsen K, Vik A, Gisvold SE, Skandsen T, Hynne H, Klepstad P. Severe head injury: control of physiological variables, organ failure and complications in the intensive care unit. Acta Anaesthesiol Scand 2007; 51 (09) 1194-1201
    PubMedGoogle Scholar
  • 28 Meyer KS, Boakye M, Marion DW. Effects of non-neurological complications on traumatic brain injury outcome. Crit Care 2012; 16 (03) 128
    CrossrefPubMedGoogle Scholar
  • 29 Vilcinis R, Bunevicius A, Tamasauskas A. The association of surgical method with outcomes of acute subdural hematoma patients: experience with 643 consecutive patients. World Neurosurg 2017; 101: 335-342
    CrossrefPubMedGoogle Scholar
  • 30 Chen SH, Chen Y, Fang WK, Huang DW, Huang KC, Tseng SH. Comparison of craniotomy and decompressive craniectomy in severely head-injured patients with acute subdural hematoma. J Trauma 2011; 71 (06) 1632-1636
    CrossrefPubMedGoogle Scholar
  • 31 Jehan F, Azim A, Rhee P. , et al. Decompressive craniectomy versus craniotomy only for intracranial hemorrhage evacuation: a propensity matched study. J Trauma Acute Care Surg 2017; 83 (06) 1148-1153
    CrossrefPubMedGoogle Scholar
  • 32 Li LM, Kolias AG, Guilfoyle MR. , et al. Outcome following evacuation of acute subdural haematomas: a comparison of craniotomy with decompressive craniectomy. Acta Neurochir (Wien) 2012; 154 (09) 1555-1561
    CrossrefPubMedGoogle Scholar
  • 33 Rincón-Ferrari MD, Flores-Cordero JM, Leal-Noval SR. , et al. Impact of ventilator-associated pneumonia in patients with severe head injury. J Trauma 2004; 57 (06) 1234-1240
    CrossrefPubMedGoogle Scholar
  • 34 Tsikritsaki K, Dimitroulis I, Dimakou K. , et al. The incidence and risk factors of ventilator associated pneumonia on the mortality in patients with traumatic brain injury. Eur Respir J 2012 40. (Suppl 56): P2476
    PubMedGoogle Scholar