AI Article Synopsis
- The study investigates the timing (T) of surgical evacuation in patients with traumatic intracranial hematoma (TICH) and its impact on mortality and neurological recovery, highlighting the lack of significant improvements in outcomes despite advancements in trauma care.
- A systematic review was conducted, analyzing 17 studies out of 1,838 screened, with mixed results regarding the association between shorter T and patient outcomes, indicating that shorter surgery times may not always lead to better results.
- The findings suggest that the 4-hour time cut-off for surgery might correlate with improved survival rates, but overall, there is limited contemporary evidence and no reduction in evacuation times over the last 33 years, necessitating further research on this key performance
Article Abstract
Background: The outcomes in traumatic intracranial hematoma (TICH) have not improved significantly despite advances in trauma care. A modifiable factor in TICH management is time to operation room (T). T has become a key marker in Traumatic brain injury care despite a lack of contemporary evidence. This study aimed to determine the timing of TICH evacuation and its association with mortality and neurological outcomes.
Methods: A systematic review of PubMed, OVID MEDLINE, CINAHL, and Web of Science. Included studies reported data on adult patients with acute TICH who underwent surgical evacuation. The primary outcome was T and its association with mortality or functional neurological recovery.
Results: From 1838 articles screened, 17 were included. Eight studies reported T as a continuous variable, ranging between 3 and 7.1 h. Three studies found better outcomes with shorter T, five found no difference, and one found worse outcomes with shorter T Five articles were included in meta-analysis of mortality in patients undergoing operative decompression less than or greater than 4 h from injury which found lower mortality in the >4-h group, OR = 1.53. Longitudinal regression analysis showed no difference in T over the 33-year span of articles included.
Conclusion: There is limited data available on T in TICH, with equivocal results on the effect of timing on outcomes. T has not decreased over the last 4 decades. The unvalidated 4-h cut-off seems to be associated with better survival. Contemporary assessment of this potentially important performance indicator is required.
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| http://dx.doi.org/10.1002/wjs.12298 | DOI Listing |
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