Operative neurosurgery for traumatic subdural hematoma: association between trauma center variation and patient outcomes
Notice bibliographique
Résumé
OBJECTIVE: Traumatic subdural hematoma (SDH) is a common form of traumatic brain injury (TBI) that often represents a neurosurgical emergency. Surgical evacuation is recommended for SDH with midline shift (MLS) > 5 mm, regardless of the presenting Glasgow Coma Scale (GCS) score; however, real-world practice is unknown. The objective of this study was to test the hypothesis that significant variation exists in the tendency for operative neurosurgical intervention for traumatic SDH among trauma centers (TCs) and that this variation is associated with patient outcomes. METHODS: The authors performed a retrospective cohort study of adult patients (age ≥ 18 years) treated for blunt severe TBI (GCS score ≤ 8) and SDH with MLS > 5 mm at level I and II TCs participating in the American College of Surgeons Trauma Quality Improvement Program (2017-2019). Patients with nonsurvivable injuries (Abbreviated Injury Scale score 6), advance directives, or emergency department death were excluded. Hierarchical logistic regression was used to estimate each TC's unique odds of performing operative neurosurgery for traumatic SDH. Risk adjustment accounted for patient baseline and injury characteristics. TCs were grouped into quartiles of increasing tendency for neurosurgery. The risk-adjusted association between TC tendency for operative neurosurgery and outcomes was then measured. The primary outcome was inpatient mortality. The secondary outcome was favorable discharge, defined as discharge to home or rehabilitation. RESULTS: The authors identified 13,087 patients with traumatic SDH treated at 454 level I and II TCs. Significant variation in TC tendency for operative neurosurgery was observed. Specifically, TCs with the greatest tendency for neurosurgical intervention (quartile 4) performed surgery on 60% of patients, whereas TCs with the lowest tendency (quartile 1) performed surgery on only 26%, even though there were no differences in GCS scores or pupillary examination findings. After risk adjustment, a greater hospital tendency for neurosurgical intervention was associated with lower inpatient mortality and higher odds of favorable discharge. Patients with traumatic SDH treated at TCs with the highest versus the lowest tendency for neurosurgery were 30% less likely to die (adjusted odds ratio [aOR] 0.7, 95% CI 0.6-0.8) and more likely to have a favorable discharge (aOR 1.3, 95% CI 1.1-1.6). These effects were most pronounced among patients with abnormal pupillary examination findings. CONCLUSIONS: Significant variation exists between trauma centers in performing operative neurosurgery for traumatic SDH. The TCs more likely to perform surgery were associated with lower odds of inpatient mortality and higher odds of a favorable discharge. Consensus-based guidelines are needed to improve standardization in the care of patients with traumatic SDH.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,006 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,002 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,000 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».