Department of Medical Sciences, Section of Neurosurgery, Uppsala University, Uppsala, SE-751 85, Sweden.
Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, SE-751 85, Sweden.
Scand J Trauma Resusc Emerg Med. 2024 Nov 15;32(1):115. doi: 10.1186/s13049-024-01290-2.
Timing of surgical evacuation of mass lesions in traumatic brain injury (TBI) is crucial. However, due to geographical variations, transportation time to the nearest neurosurgical department may be long. To save time, general surgeons at a local hospital may perform the operation, despite more limited experience in neurosurgical techniques. This study aimed to determine whether patient outcomes differed between those who had undergone emergency neurosurgery at local hospitals by general surgeons vs. at university hospitals by neurosurgeons.
A nationwide observational study was performed using data from the Swedish Trauma Registry (SweTrau) between 2018 and 2022. A total of 565 TBI patients (local hospitals, n = 21; university hospitals, n = 544) who underwent intracranial hematoma evacuation within 8 h after arrival at the hospital were included. Data on demography, admission variables, traumatic injuries, and outcome (Glasgow Outcome Scale [GOS]) at discharge were evaluated. Favourable vs. unfavourable outcomes were defined as GOS scores of 4-5 vs. 1-3.
Compared with those treated at university hospitals, patients treated with intracranial hematoma evacuation at local hospitals had lower median Glasgow Coma Scale (GCS) scores (8 vs. 12, p < 0.001), higher rate of acute subdural hematomas (86% vs. 77%, p < 0.001), and lower rate of contusions (14% vs. 53%, p = 0.01). Being operated on at a local hospital was independently associated with higher mortality (p = 0.03) but with a similar rate of favourable outcome (p = 0.74) in multiple logistic regressions after adjustment for demographic and injury-related variables.
Although a slightly greater proportion of patients who underwent emergency neurosurgery at local hospitals died, there was no difference in the rate of favourable outcome. Thus, in patients with impending brain herniation, when time is of the essence, evacuation of traumatic intracranial bleeding by general surgeons at local hospitals remains a highly viable option.
创伤性脑损伤（TBI）中肿块病变的手术清除时机至关重要。然而，由于地理位置的差异，到最近的神经外科部门的转运时间可能很长。为了节省时间，当地医院的普通外科医生可能会进行手术，尽管他们在神经外科技术方面的经验更为有限。本研究旨在确定由普通外科医生在当地医院进行紧急神经外科手术与由神经外科医生在大学医院进行手术的患者结局是否存在差异。
本研究使用了 2018 年至 2022 年期间瑞典创伤登记处（SweTrau）的数据进行了一项全国性观察性研究。共纳入了 565 名 TBI 患者（当地医院 21 例；大学医院 544 例），这些患者在到达医院后 8 小时内接受了颅内血肿清除术。评估了人口统计学、入院变量、创伤性损伤以及出院时的结局（格拉斯哥结局量表[GOS]）。将有利结局定义为 GOS 评分为 4-5 分，不利结局定义为 GOS 评分为 1-3 分。
与在大学医院接受治疗的患者相比，在当地医院接受颅内血肿清除术的患者的中位格拉斯哥昏迷评分（GCS）较低（8 分 vs. 12 分，p<0.001），急性硬膜下血肿发生率较高（86% vs. 77%，p<0.001），脑挫裂伤发生率较低（14% vs. 53%，p=0.01）。多变量逻辑回归分析调整人口统计学和损伤相关变量后，在当地医院接受手术与死亡率升高相关（p=0.03），但与有利结局的发生率无差异（p=0.74）。
尽管在当地医院接受紧急神经外科手术的患者死亡比例略高，但有利结局的比例没有差异。因此，在即将发生脑疝的患者中，时间至关重要时，由当地医院的普通外科医生清除创伤性颅内出血仍然是一种可行的选择。
