gms | German Medical Science

Objective: 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 prospective multicenter cohort study we tried to analyse the timing of initial diagnostic and curative measures.

Methods: 1003 patients admitted in posttraumatic coma were followed in 16 hospitals. The timing of surgical management and outcome was analysed in the early phase - within 48 hours – and late phase – until 6 months -. Statistical analysis included chi-square and NANOVA tests.

Results: Vital operations within 48h of the injury were 348 cases of craniotomy, 78 cases of abdominal and 84 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.

Conclusion: The most frequent vital surgical procedure of comatose patients within 8 hours of the accident was a craniotomy (68.2%). Vital surgery of the thorax or abdomen was necessary in 31.8%. Based on the mortality of specific neurological findings, secondary non vital surgery should be delayed, until the condition of the patient is stable and survival appears likely. When the patient is in a coma, the most frequent type of surgery performed is a neurosurgical procedure.