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Association Between Intoxication and Urgent Neurosurgical Procedures in Severe Traumatic Brain Injury: Results From the American College of Surgeons Trauma Quality Improvement Program

BACKGROUND: The probability of undergoing surgery after severe traumatic brain injury (TBI) varies significantly across studies and centers. However, causes of this variability are poorly understood. We hypothesized that intoxication may impact the probability of receiving an urgent neurosurgical pr...

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Autores principales: Tillmann, Bourke W., Nathens, Avery B., Scales, Damon C., Haas, Barbara
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8772018/
https://www.ncbi.nlm.nih.gov/pubmed/34013826
http://dx.doi.org/10.1177/08850666211017497
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author Tillmann, Bourke W.
Nathens, Avery B.
Scales, Damon C.
Haas, Barbara
author_facet Tillmann, Bourke W.
Nathens, Avery B.
Scales, Damon C.
Haas, Barbara
author_sort Tillmann, Bourke W.
collection PubMed
description BACKGROUND: The probability of undergoing surgery after severe traumatic brain injury (TBI) varies significantly across studies and centers. However, causes of this variability are poorly understood. We hypothesized that intoxication may impact the probability of receiving an urgent neurosurgical procedure among patients with severe TBI. METHODS: We performed a retrospective cohort study of adult patients admitted to a Level I or II trauma center in the United States or Canada with an isolated severe TBI (2012–2016). Data were derived from the Trauma Quality Improvement Program dataset. An urgent neurosurgical procedure was defined as a procedure that occurred within 24 hours of admission. Multivariable logistic regression was utilized to examine the independent effect of intoxication on a patient’s likelihood of undergoing an urgent procedure, as well as the timing of the procedure. RESULTS: Of the 33,646 patients with an isolated severe TBI, 11,313 (33.6%) were intoxicated. An urgent neurosurgical procedure was performed in 8,255 (24.5%) cases. Overall, there was no difference in the probability of undergoing an urgent procedure between patients who were and were not intoxicated (OR 0.99; 95% CI 0.94–1.06). While intoxication status had no impact on the probability of surgery among patients with the most severe TBI (head AIS 5: OR 1.06 [95% CI 0.98–1.15]), intoxicated patients on the lower spectrum of injury had lower odds of undergoing an urgent procedure (AIS 3: OR 0.80 [95% CI 0.66–0.97]). Among patients who underwent an urgent procedure, intoxication had no impact on timing. CONCLUSION: Intoxication status was not associated with differences in the probability of undergoing an urgent neurosurgical procedure among all patients with a severe TBI. However, in patients with less severe TBI, intoxication status was associated with decreased likelihood of receiving an urgent intervention. This finding underscores the challenge in the management of intoxicated patients with TBI.
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spelling pubmed-87720182022-01-21 Association Between Intoxication and Urgent Neurosurgical Procedures in Severe Traumatic Brain Injury: Results From the American College of Surgeons Trauma Quality Improvement Program Tillmann, Bourke W. Nathens, Avery B. Scales, Damon C. Haas, Barbara J Intensive Care Med Original Research BACKGROUND: The probability of undergoing surgery after severe traumatic brain injury (TBI) varies significantly across studies and centers. However, causes of this variability are poorly understood. We hypothesized that intoxication may impact the probability of receiving an urgent neurosurgical procedure among patients with severe TBI. METHODS: We performed a retrospective cohort study of adult patients admitted to a Level I or II trauma center in the United States or Canada with an isolated severe TBI (2012–2016). Data were derived from the Trauma Quality Improvement Program dataset. An urgent neurosurgical procedure was defined as a procedure that occurred within 24 hours of admission. Multivariable logistic regression was utilized to examine the independent effect of intoxication on a patient’s likelihood of undergoing an urgent procedure, as well as the timing of the procedure. RESULTS: Of the 33,646 patients with an isolated severe TBI, 11,313 (33.6%) were intoxicated. An urgent neurosurgical procedure was performed in 8,255 (24.5%) cases. Overall, there was no difference in the probability of undergoing an urgent procedure between patients who were and were not intoxicated (OR 0.99; 95% CI 0.94–1.06). While intoxication status had no impact on the probability of surgery among patients with the most severe TBI (head AIS 5: OR 1.06 [95% CI 0.98–1.15]), intoxicated patients on the lower spectrum of injury had lower odds of undergoing an urgent procedure (AIS 3: OR 0.80 [95% CI 0.66–0.97]). Among patients who underwent an urgent procedure, intoxication had no impact on timing. CONCLUSION: Intoxication status was not associated with differences in the probability of undergoing an urgent neurosurgical procedure among all patients with a severe TBI. However, in patients with less severe TBI, intoxication status was associated with decreased likelihood of receiving an urgent intervention. This finding underscores the challenge in the management of intoxicated patients with TBI. SAGE Publications 2021-05-20 2022-03 /pmc/articles/PMC8772018/ /pubmed/34013826 http://dx.doi.org/10.1177/08850666211017497 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/This article is distributed under the terms of the Creative Commons Attribution 4.0 License (https://creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle Original Research
Tillmann, Bourke W.
Nathens, Avery B.
Scales, Damon C.
Haas, Barbara
Association Between Intoxication and Urgent Neurosurgical Procedures in Severe Traumatic Brain Injury: Results From the American College of Surgeons Trauma Quality Improvement Program
title Association Between Intoxication and Urgent Neurosurgical Procedures in Severe Traumatic Brain Injury: Results From the American College of Surgeons Trauma Quality Improvement Program
title_full Association Between Intoxication and Urgent Neurosurgical Procedures in Severe Traumatic Brain Injury: Results From the American College of Surgeons Trauma Quality Improvement Program
title_fullStr Association Between Intoxication and Urgent Neurosurgical Procedures in Severe Traumatic Brain Injury: Results From the American College of Surgeons Trauma Quality Improvement Program
title_full_unstemmed Association Between Intoxication and Urgent Neurosurgical Procedures in Severe Traumatic Brain Injury: Results From the American College of Surgeons Trauma Quality Improvement Program
title_short Association Between Intoxication and Urgent Neurosurgical Procedures in Severe Traumatic Brain Injury: Results From the American College of Surgeons Trauma Quality Improvement Program
title_sort association between intoxication and urgent neurosurgical procedures in severe traumatic brain injury: results from the american college of surgeons trauma quality improvement program
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8772018/
https://www.ncbi.nlm.nih.gov/pubmed/34013826
http://dx.doi.org/10.1177/08850666211017497
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