Clinical profile of patients with acute traumatic brain injury undergoing cranial surgery in the United States: report from the 18-centre TRACK-TBI cohort study

John K Yue; John H Kanter; Jason K Barber; Michael C Huang; Thomas A van Essen; Mahmoud M Elguindy; Brandon Foreman; Frederick K Korley; Patrick J Belton; Dana Pisică; Young M Lee; Ryan S Kitagawa; Mary J Vassar; Xiaoying Sun; Gabriela G Satris; Justin C Wong; Adam R Ferguson; J Russell Huie; Kevin K W Wang; Hansen Deng; Vincent Y Wang; Yelena G Bodien; Sabrina R Taylor; Debbie Y Madhok; Michael A McCrea; Laura B Ngwenya; Anthony M DiGiorgio; Phiroz E Tarapore; Murray B Stein; Ava M Puccio; Joseph T Giacino; Ramon Diaz-Arrastia; Hester F Lingsma; Pratik Mukherjee; Esther L Yuh; Claudia S Robertson; David K Menon; Andrew I R Maas; Amy J Markowitz; Sonia Jain; David O Okonkwo; Nancy R Temkin; Geoffrey T Manley; TRACK-TBI Investigators

doi:10.1016/j.lana.2024.100915

Clinical profile of patients with acute traumatic brain injury undergoing cranial surgery in the United States: report from the 18-centre TRACK-TBI cohort study

Lancet Reg Health Am. 2024 Oct 17:39:100915. doi: 10.1016/j.lana.2024.100915. eCollection 2024 Nov.

Authors

John K Yue^{1

2}, John H Kanter^{1

2}, Jason K Barber³, Michael C Huang^{1

2}, Thomas A van Essen^{4

5}, Mahmoud M Elguindy^{1

2}, Brandon Foreman⁶, Frederick K Korley⁷, Patrick J Belton⁸, Dana Pisică^{9

10}, Young M Lee^{1

2}, Ryan S Kitagawa¹¹, Mary J Vassar^{1

2}, Xiaoying Sun¹², Gabriela G Satris^{1

2}, Justin C Wong^{1

2}, Adam R Ferguson^{1

2}, J Russell Huie^{1

2}, Kevin K W Wang¹³, Hansen Deng¹⁴, Vincent Y Wang¹⁵, Yelena G Bodien¹⁶, Sabrina R Taylor^{1

2}, Debbie Y Madhok¹⁷, Michael A McCrea¹⁸, Laura B Ngwenya¹⁹, Anthony M DiGiorgio^{1

2}, Phiroz E Tarapore^{1

2}, Murray B Stein²⁰, Ava M Puccio¹³, Joseph T Giacino²¹, Ramon Diaz-Arrastia²², Hester F Lingsma⁹, Pratik Mukherjee^{2

23}, Esther L Yuh^{2

23}, Claudia S Robertson²⁴, David K Menon²⁵, Andrew I R Maas^{26

27}, Amy J Markowitz^{1

2}, Sonia Jain¹², David O Okonkwo¹⁴, Nancy R Temkin³, Geoffrey T Manley^{1

2}; TRACK-TBI Investigators

Collaborators

Affiliations

¹ Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States.
² Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA, United States.
³ Departments of Neurological Surgery and Biostatistics, University of Washington, Seattle, WA, United States.
⁴ University Neurosurgical Center Holland, Leiden University Medical Center, Haaglanden Medical Center, HAGA, Leiden, The Hague, the Netherlands.
⁵ Department of Surgery, Division of Neurosurgery, QEII Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada.
⁶ Department of Neurology, University of Cincinnati, Cincinnati, OH, United States.
⁷ Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, United States.
⁸ Department of Neurological Surgery, University of Wisconsin-Madison, Madison, WI, United States.
⁹ Center for Medical Decision Making, Department of Epidemiology and Public Health, Erasmus MC, University Center Rotterdam, Rotterdam, the Netherlands.
¹⁰ Department of Neurosurgery, Erasmus MC - University Medical Center Rotterdam, Rotterdam, the Netherlands.
¹¹ Department of Neurological Surgery, The University of Texas Health Science Center at Houston, Houston, TX, United States.
¹² Biostatistics Research Center, Herbert Wertheim School of Public Health and Longevity Science, University of California San Diego, La Jolla, CA, United States.
¹³ Department of Neurobiology, Morehouse School of Medicine, Atlanta, GA, United States.
¹⁴ Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States.
¹⁵ Department of Neurological Surgery, University of Texas at Austin, Austin, TX, United States.
¹⁶ Department of Neurology, Harvard Medical School, Boston, MA, United States.
¹⁷ Departments of Emergency Medicine and Neurology, University of California, San Francisco, San Francisco, CA, United States.
¹⁸ Department of Neurological Surgery, Medical College of Wisconsin, Milwaukee, WI, United States.
¹⁹ Department of Neurological Surgery, University of Cincinnati, Cincinnati, OH, United States.
²⁰ Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States.
²¹ Department of Rehabilitation Medicine, Spaulding Rehabilitation Center, Boston, MA, United States.
²² Department of Neurology, University of Pennsylvania, Philadelphia, PA, United States.
²³ Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States.
²⁴ Department of Neurological Surgery, Baylor College of Medicine, Houston, TX, United States.
²⁵ Division of Anaesthesia, Department of Medicine, University of Cambridge, Cambridge, United Kingdom.
²⁶ Department of Neurological Surgery, Antwerp University Hospital, Edegem, Belgium.
²⁷ Department of Translational Neuroscience, University of Antwerp, Antwerp, Belgium.

Abstract

Background: Contemporary surgical practices for traumatic brain injury (TBI) remain unclear. We describe the clinical profile of an 18-centre US TBI cohort with cranial surgery.

Methods: The prospective, observational Transforming Research and Clinical Knowledge in Traumatic Brain Injury Study (2014-2018; ClinicalTrials.gov #NCT02119182) enrolled subjects who presented to trauma centre and received head computed tomography within 24-h (h) post-TBI. We performed a secondary data analysis in subjects aged ≥17-years with hospitalisation. Clinical characteristics, surgery type/timing, hospital and six-month outcomes were reported.

Findings: Of 2032 subjects (age: mean = 41.4-years, range = 17-89-years; male = 71% female = 29%), 260 underwent cranial surgery, comprising 65% decompressive craniectomy, 23% craniotomy, 12% other surgery. Subjects with surgery (vs. without surgery) presented with worse neurological injury (median Glasgow Coma Scale = 6 vs. 15; midline shift ≥5 mm: 48% vs. 2%; cisternal effacement: 61% vs. 4%; p < 0.0001). Median time-to-craniectomy/craniotomy was 1.8 h (interquartile range = 1.1-5.0 h), and 67% underwent intracranial pressure monitoring. Seventy-three percent of subjects with decompressive craniectomy and 58% of subjects with craniotomy had ≥3 intracranial lesion types. Decompressive craniectomy (vs. craniotomy) was associated with intracranial injury severity (median Rotterdam Score = 4 vs. 3, p < 0.0001), intensive care length of stay (median = 13 vs. 4-days, p = 0.0002), and six-month unfavourable outcome (62% vs. 30%; p = 0.0001). Earlier time-to-craniectomy was associated with intracranial injury severity.

Interpretation: In a large representative cohort of patients hospitalised with TBI, surgical decision-making and time-to-surgery aligned with intracranial injury severity. Multifocal TBIs predominated in patients with cranial surgery. These findings summarise current TBI surgical practice across US trauma centres and provide the foundation for analyses in targeted subpopulations.

Funding: National Institute of Neurological Disorders and Stroke; US Department of Defense; Neurosurgery Research and Education Foundation.

Keywords: Craniotomy; Decompressive craniectomy; Glasgow outcome scale; Medical decisionmaking; Neuroimaging; Traumatic brain injury; Traumatic intracranial hemorrhage; Triage.

Associated data

ClinicalTrials.gov/NCT02119182