De Vloo Philippe, Nijs Stefaan, Verelst Sandra, van Loon Johannes, Depreitere Bart
Department of Neurosurgery, University Hospitals Leuven, KU Leuven, Leuven, Belgium.
Department of Traumatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium.
World Neurosurg. 2018 Jun;114:e546-e558. doi: 10.1016/j.wneu.2018.03.032. Epub 2018 Mar 13.
According to level 2 evidence, earlier evacuation of acute subdural or epidural hematomas necessitating surgery is associated with better outcome. Hence, guidelines recommend performing these procedures immediately. Literature on the extent and causes of prehospital and intrahospital intervals in patients with trauma requiring emergent craniotomies is almost completely lacking. Studies delineating and refining the interval before thrombolytic agent administration in ischemic stroke have dramatically reduced the door-to-needle time. A similar exercise for trauma-to-decompression time might result in comparable reductions. We aim to map intervals in emergent trauma craniotomies in our level 1 trauma center, screen for associated factors, and propose possible ways to reduce these intervals.
We analyzed patients who were primarily referred (1R; n = 45) and secondarily referred (after computed tomography imaging in a community hospital [2R; n = 22]) to our emergency department (ED) and underwent emergent trauma craniotomies between 2010 and 2016.
Median prehospital interval (between emergency call and arrival at the ED) was 42 minutes for 1R patients. Median intrahospital interval (between initial ED arrival and skin incision [SI]) was 140 minutes and 268 minutes for 1R and 2R patients, respectively. In 1R patients, ED-SI interval was positively correlated with Glasgow Coma Scale score (ρ=.49; P < 0.001), but not with age, time of ED arrival, or extended Glasgow Outcome Scale score at 6 months. Based on outlier analysis, we propose prehospital and intrahospital measures to improve performance.
This is the first report on emergency call-SI interval in emergent trauma craniotomy, with a median of 174 minutes and >297 minutes for 1R and 2R patients, respectively, in our center.
根据二级证据，对于需要手术治疗的急性硬膜下或硬膜外血肿，尽早进行血肿清除与更好的预后相关。因此，指南建议立即实施这些手术。目前几乎完全缺乏关于需要紧急开颅手术的创伤患者的院前和院内间隔时间的长短及原因的文献。描述并缩短缺血性卒中患者溶栓治疗前的间隔时间的研究已显著缩短了门到针时间。类似地缩短创伤到减压的时间可能会带来可比的效果。我们旨在梳理我们一级创伤中心紧急创伤开颅手术中的间隔时间，筛查相关因素，并提出缩短这些间隔时间的可能方法。
我们分析了2010年至2016年间主要转诊（1R；n = 45）和次要转诊（在社区医院进行计算机断层扫描成像后转诊[2R；n = 22]）至我们急诊科并接受紧急创伤开颅手术的患者。
1R患者的院前间隔时间（从紧急呼叫到抵达急诊科）中位数为42分钟。1R和2R患者的院内间隔时间（从最初抵达急诊科到皮肤切开[SI]）中位数分别为140分钟和268分钟。在1R患者中，急诊科到皮肤切开的间隔时间与格拉斯哥昏迷量表评分呈正相关（ρ = 0.49；P < 0.001），但与年龄、抵达急诊科的时间或6个月时的扩展格拉斯哥预后量表评分无关。基于离群值分析，我们提出了院前和院内的改进措施。
这是关于紧急创伤开颅手术中紧急呼叫到皮肤切开间隔时间的首份报告，在我们中心，1R和2R患者的该间隔时间中位数分别为174分钟和>297分钟。
