Surgical outcomes in a large traumatic Intraparenchymal hemorrhage.

BACKGROUND

This study was designed to evaluate the outcomes of patients with Traumatic Brain Injury (TBI) who presented with a supratentorial Intraparenchymal hemorrhage (IPH) volume > 30 cc. We hypothesized that operative intervention would result in better mortality outcome.

METHODS

Trauma Quality Improvement Program (TQIP) database of 2019-2023 was queried for the project. Patients' demographic information and clinical characteristics and injury type and injury severity score (ISS), Glasgow Coma Scale (GCS) score and outcomes were compared between the groups who underwent craniotomy or craniectomy (CR) and the group who received medical management (MM). Propensity score matching was performed and a p value of < 0.05 was considered statistically significant.

RESULTS

Propensity score matching created 486 pairs of patients. Pair-matched analysis showed no significant differences between the MM and the CR groups regarding age (63 [48-74] vs. 63 [49.3-74],P = 0.815), ISS (median [IQR] 26 [26-30] vs. 26 [26-30], P = 0.47, GCS (median [IQR] 11 [4-14.75] vs. 10 [5 -14], P = 0.668), both reactive pupils (79.8% vs. 82.1%) and significant midline shift (72.2% vs. 72.2 %,). Pair matched analysis showed CR group had significant lower in-hospital mortality (30.9% vs. 38.1%, (odds ratio[95%CI], 0.715 [0.538, 0.948]) ,P = 0.019) when compared to MM group. However, CR patients found to have longer hospital stay and more post operative complications compared to MM group.

CONCLUSION

Operative intervention was associated with significant improvement in mortality for a large IPH volume when compared to MM group.