Incidence of emergency neurosurgical TBI procedures: A population-based study

Abstract

Background The rates of emergency neurosurgery in traumatic brain injury (TBI) patients vary between populations and trauma centers. In planning acute TBI treatment, knowledge about rates and incidence of emergency neurosurgery at the population level is of importance. This study aimed to present incidence rates and patient characteristics for the most common TBI-related emergency neurosurgical procedures. Methods Oslo University Hospital is the only trauma center with neurosurgical services in Southeast Norway, which has a population of 3 million. We extracted prospectively collected registry data from the Oslo TBI Registry – Neurosurgery over a five-year period (2015–2019). For age-adjusted incidence according to the direct method, we used the 2013 European standard population (ESP) and 2000–2025 WHO World standard population distributions. We conducted multivariate logistic regression models to assess variables associated with emergency neurosurgical procedures. Results A total of 2151 patients with pathological head CT scans were included. One or more emergency neurosurgical procedure was performed in 27% of patients. The crude incidence was 3.9/100 000 person-years. The age-adjusted incidences in the standard population for Europe and the world were 4.0/100 00 and 3.3/100 000, respectively. The most frequent emergency neurosurgical procedure was the insertion of an intracranial pressure monitor, followed by evacuation of the mass lesion. Male sex, road traffic accidents, severe injury (low GCS) and CT characteristics such as midline shift and compressed/absent basal cisterns were significantly associated with an increased probability of emergency neurosurgery, while older age was associated with a decreased probability. Conclusions The incidence of emergency neurosurgery in the general population is low and reflects neurosurgery procedures performed in patients with severe injuries. Hence, emergency neurosurgery for TBIs should be centralized to major trauma centers.

Referrals to Early Specialized Rehabilitation after Traumatic Brain Injury during the Covid-19 Pandemic

“…In the multivariable model, strong positive factors in both groups were younger age, pre-injury ASA-score 1-2, severe TBI, severe disability due to TBI upon discharge, in line with a previous study (14). We cannot fully explain the variation regarding male sex, but contributing factors may be that in younger TBI patients, males are over-represented and males more often need emergency neurosurgery (29,30). Interestingly, we found a difference in favour of the group who received neurosurgical procedure with ICP-sensor insertion in the pandemic group, although the difference was not statistically significant.…”

Epidemiology of Traumatic Cervical Spinal Fractures in a General Western Population

“…Given a rate of CS-Fx surgery of 3.7/100,000 person-years, centralization of this kind of surgery is necessary to maintain a competent 24/7 surgical service for these patients. Emergency neurosurgery for traumatic brain injury is also centralized in Norway, and the crude incidence for such procedures in Norway is 3.9/100 000 person-years [44].…”

Predictive Factors of Outcomes in Acute Subdural Hematoma Evacuation

“…They critically analyzed the value-based cost-effectiveness of surgical treatment of patients with traumatic acute subdural hematoma. Tverdal et al in 2022 studied neurosurgical emergency procedures at their center and came up with the findings that patients with old age and low GCS at time of injury were more at risk of poor outcomes [ 8 ]. Portuguese patients were studied in 2018 for predictive factors of poor outcomes in patients who underwent evacuation of acute subdural hematoma [ 9 ].…”