gms | German Medical Science

60th Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Benelux countries and Bulgaria

German Society of Neurosurgery (DGNC)

24 - 27 May 2009, Münster

The time factor in the treatment of head injury – results of a multicenter study

Meeting Abstract

  • B. Völlger - Klinik für Neurochirurgie, Otto-von-Guericke-Universität, Magdeburg
  • Z. Barelkowska - Klinik für Neurochirurgie, Otto-von-Guericke-Universität, Magdeburg
  • D.H. Woischneck - Klinik für Neurochirurgie der Universität Ulm
  • R. Firsching - Klinik für Neurochirurgie, Otto-von-Guericke-Universität, Magdeburg

Deutsche Gesellschaft für Neurochirurgie. 60. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit den Benelux-Ländern und Bulgarien. Münster, 24.-27.05.2009. Düsseldorf: German Medical Science GMS Publishing House; 2009. DocMO.02-02

DOI: 10.3205/09dgnc002, URN: urn:nbn:de:0183-09dgnc0020

Published: May 20, 2009

© 2009 Völlger et al.
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Outline

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Objective: Physicians involved in emergency room management of patients with multiple injuries frequently face a collision of priorities. This study aims to analyse the effect of timing on outcome in comatose patients with multiple injuries.

Methods: The management of 294 patients with multiple injuries admitted to a neurosurgical department in coma and with no signs of respiratory or cardiovascular instability was analysed. Neurological state, respiratory and cardiovascular parameters, and timing of diagnostic and therapeutic measures were recorded. Outcome was assessed with Glasgow Outcome Score (GOS) and return to work, both 6 months after injury. Statistical tests included Shapiro Wilk, Wilcoxon and Chi square. P<0.05 was supposed to be statistically significant.

Results: Mean interval from accident to cranial computerized tomography (CCT) was 128 minutes. Mean interval from admission to CCT was 27 minutes. Most delays after admission were due to recording of history (n=222) and blood sampling (n=187). Longest delays after admission were due to delayed availability of CT (mean: 11 minutes) and transportation (mean: 7 minutes). Urgent surgery for space-occupying intracranial hematomas was required in 21.8% (64 patients). 6 month mortality was 18.1%. Patients requiring urgent surgery for space-occupying intracranial hematomas showed a significant increase in 6 month mortality to 40.7% and a significant decrease in 6 month GOS, whereas return to work was not significantly affected. Mortality significantly increased to 85.7% in those intracranial hematomas which were removed later than 2 hours after the injury.

Conclusions: In comatose patients with multiple injuries, space-occupying intracranial hematomas occur frequently and lead to increased morbidity and mortality. Fast and efficient timing is significantly correlated with reduced mortality in comatose patients with space-occupying intracranial hematomas. Comatose patients with multiple injuries should be admitted to a neurosurgical department without delay. In the interdisciplinary setting of the emergency room the neurosurgeon should see to a CCT attained as soon as respiratory and cardiovascular functions are stable.