Multiple significant trauma with craniotomy: What impacts mortality?

Objective: The management of patients suffering traumatic brain injury (TBI) in the context of multiple significant trauma represents one of the most challenging scenarios in trauma critical care. The identification of risk factors, utilizing large national databases, may help in developing medical strategies and health care policies aimed at improving outcomes in these patients. In this study, our aim was to assess in-hospital mortality following craniotomy for multiple significant trauma in the United States. Patient and methods: A retrospective cohort study was conducted using the Nationwide Inpatient Sample (NIS) on subjects having “Craniotomy with Multiple Significant Trauma” between 2008–2016. Multivariate logistic regression was used to find the impact of selected variables on the odds of mortality. Results: There were 26,650 discharges within the study period that were predominantly male (73.2%), white (65.1%), with a mean age of 39.7 ± 22.3, and in-hospital mortality of 35.4%. During the study period, the mortality of this population increased from 34.8% to 38.3% (p = 0.18). In a multivariate logistic regression analysis, the following conditions were associated with higher mortality: being on pressors (OR: 8.41; CI 95% 5.55–12.75, p = 0), having Status Epilepticus (OR: 3.33; CI 95% 1.26–8.81, p = 0.015), self-pay (OR: 4.81; CI 95% 1.49–2.59, p = 0), privately insured (OR: 1.97; CI 95% 1.49–2.59, p = 0) and discharge from urban teaching hospitals (OR = 1.4; CI 95% 1.16–1.68, p = 0). Conclusion: Patients who underwent craniotomy with multiple significant trauma had high mortality, at a rate of about one in three; mortality has been increasing during recent years. Those who required vasopressors and those who developed Status Epilepticus had a significant association with higher death. These associations may be due to the complexity of injuries in this population. Patients with these conditions should seek further attention by the clinicians. Further studies are warranted to characterize these differences.