Association between cranial surgery and mortality among patients with firearm-related traumatic brain injury resulting in subdural hematoma.

IF 3.6 2区医学 Q1 CLINICAL NEUROLOGY

Journal of neurosurgery Pub Date : 2025-06-27 Print Date: 2025-10-01 DOI:10.3171/2025.3.JNS242450

Kathleen R Ran, Jiaqi Liu, Vikas N Vattipally, Richard Cook, Sruthi Ranganathan, Jacob Jo, Jowah Gorbachev, John R Williams, Jordina Rincon-Torroella, Elliott R Haut, Jose I Suarez, Judy Huang, Chetan Bettegowda, James P Byrne, Tej D Azad

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引用次数: 0

Abstract

Objective: Firearm-related penetrating traumatic brain injury (pTBI) is highly morbid and causes heterogeneous intracranial injury patterns. As guidelines and practices evolve, tailored analysis of more homogeneous pTBI cohorts is needed to inform surgical management. Therefore, the aim of this study was to test the association between cranial surgery and survival among patients with pTBI resulting in subdural hematoma (SDH).

Methods: Patients with firearm-related pTBI and resultant SDH were retrospectively identified using the American College of Surgeons Trauma Quality Program dataset (2017-2019). The study exposure of interest was cranial surgery, and the primary outcome was in-hospital mortality. Adjusted hierarchical regression models were specified to test the association between cranial surgery and in-hospital mortality. To further increase the homogeneity of the presenting injury pattern, a subgroup analysis was performed in patients with SDH and midline shift (MLS) > 5 mm.

Results: A total of 1894 patients (84% male; median age 31 years) with firearm-related pTBI and SDH were included. The hierarchical logistic regression analysis demonstrated that cranial surgery was independently associated with lower odds of in-hospital mortality (OR 0.49, 95% CI 0.34-0.71; p < 0.001), even after risk adjustment for injury characteristics and placement of an external ventricular drain or intracranial pressure monitor. In a subgroup of 535 patients who presented with SDH and MLS > 5 mm, cranial surgery had a greater protective effect against in-hospital mortality (OR 0.40, 95% CI 0.24-0.67; p < 0.001).

Conclusions: Cranial surgery was independently associated with lower in-hospital mortality among patients with firearm-related pTBI and SDH, and its protective effect was greater among patients with significant MLS. Further investigations of long-term functional outcomes are needed.

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颅脑手术与枪械相关外伤性脑损伤导致硬膜下血肿患者死亡率的关系

目的：火器性穿透性颅脑损伤（pTBI）是一种发病率高且具有异质性的颅脑损伤类型。随着指南和实践的发展，需要对更均匀的pTBI队列进行量身定制的分析，以告知手术管理。因此，本研究的目的是测试颅脑手术与导致硬膜下血肿（SDH）的pTBI患者生存之间的关系。方法：使用美国外科医师学会创伤质量计划数据集（2017-2019）回顾性识别枪支相关pTBI和由此产生的SDH患者。研究对象为颅脑手术，主要结局为住院死亡率。采用调整后的分层回归模型检验颅外科手术与住院死亡率之间的关系。为了进一步增加呈现损伤模式的均匀性，我们对SDH和中线移位（MLS）患者进行了亚组分析，中线移位（MLS）为50mm。结果：共有1894例患者(84%男性；中位年龄31岁)，包括与枪支相关的pTBI和SDH。分层logistic回归分析显示，颅脑手术与较低的院内死亡率独立相关(OR 0.49, 95% CI 0.34-0.71；P < 0.001)，即使在对损伤特征进行风险调整并放置外脑室引流或颅内压监测仪后也是如此。在535例SDH和MLS患者的亚组中，颅脑手术对院内死亡率有更大的保护作用(OR 0.40, 95% CI 0.24-0.67；P < 0.001)。结论：颅脑手术与枪支相关性pTBI和SDH患者较低的住院死亡率独立相关，且颅脑手术对MLS患者的保护作用更大。需要对长期功能结果进行进一步研究。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of neurosurgery 医学-临床神经学

CiteScore

7.20

自引率

7.30%

发文量

1003

审稿时长

1 months

期刊介绍： The Journal of Neurosurgery, Journal of Neurosurgery: Spine, Journal of Neurosurgery: Pediatrics, and Neurosurgical Focus are devoted to the publication of original works relating primarily to neurosurgery, including studies in clinical neurophysiology, organic neurology, ophthalmology, radiology, pathology, and molecular biology. The Editors and Editorial Boards encourage submission of clinical and laboratory studies. Other manuscripts accepted for review include technical notes on instruments or equipment that are innovative or useful to clinicians and researchers in the field of neuroscience; papers describing unusual cases; manuscripts on historical persons or events related to neurosurgery; and in Neurosurgical Focus, occasional reviews. Letters to the Editor commenting on articles recently published in the Journal of Neurosurgery, Journal of Neurosurgery: Spine, and Journal of Neurosurgery: Pediatrics are welcome.