gms | German Medical Science

Introduction: As a patient in posttraumatic coma cannot choose the treatment he needs, a multidisciplinary team of specialists has the responsibility to determine what is urgent in a collision of priorities. In a multicenter study we tried to analyse the timing of initial curative measures.

Patients and Methods: 1,003 patients admitted in posttraumatic coma were followed in 16 hospitals retrospectively. The timing of diagnostic and surgical management was analysed in the early phase – within 48 hours – and late phase – until 6 months. Statistical analysis included chi square and anova tests.

Results: Vital operations within 48h of the injury were 237 cases of craniotomy, 35 cases of abdominal and 30 thoracic operations. Non-vital operations included 220 intracranial catheters for ICP recording, 160 definitive or provisional stabilizations of fractures extremities, 55 maxillofacial operations and 35 spinal operations. In 5 cases the cranial operation was performed prior to the abdominal operation. In 2 cases the abdominal operation preceded the craniotomy, in 5 cases the thoracic intervention preceded the craniotomy. In 7 cases craniotomy was performed simultaneously with either abdominal or thoracic surgery. Mortality correlated highly significantly with the duration of coma and additional neurological disorders and lesions of the thorax and abdomen.

Conclusion: The most frequent vital surgical procedure of comatose patients within 8 hours of the accident was a craniotomy (34,7%). Vital surgery of the thorax or abdomen was necessary in 16%. Based on the neurological findings as related with mortality, secondary non vital surgery should be delayed, until the condition of the patient is stable and survival appears likely.