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. 2022 Jan 6;22(1):1.
doi: 10.1186/s12873-021-00561-w.

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

Cathrine Tverdal  1   2 , Mads Aarhus  3 , Pål Rønning  3 , Ola Skaansar  3   4 , Karoline Skogen  5 , Nada Andelic  6   7 , Eirik Helseth  3   4
Affiliations

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

Cathrine Tverdal et al. BMC Emerg Med. .

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 for organization and planning of specialized health care services. 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). Incidence was calculated in person-pears (crude) and age-adjusted for standard population. We conducted multivariate multivariable 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 4.0/100,000 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 Glasgow coma score) 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.

Keywords: Emergency; Incidence; Neurosurgery; Trauma center; Traumatic brain injury.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Fig. 1
Fig. 1
Age-stratified incidence of emergency neurosurgery in the population of Southeast Norway. Incidence was calculated in person years for all age groups, with data from five years (2015–2019). Emergency neurosurgery includes patients undergoing one or more of the following procedures: ICP monitoring, evacuation of intracranial mass lesions, decompressive craniectomy, and external ventricular drain
Fig. 2
Fig. 2
A Emergency neurosurgical procedures within age groups. Number of cases by age group undergoing emergency neurosurgery over five years (2015–2019). B The type of intracranial mass lesions evacuated within age groups. Redo surgery is not included. Abbreviations ICP: intracranial pressure; EVD: external ventricular drain; DC: decompressive craniectomy; ASDH: acute subdural hematoma; EDH: epidural hematoma
See this image and copyright information in PMC

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