Association Between Operative Neurosurgical Intervention and Favorable Discharge Among Patients With Traumatic Subdural Hematoma and Poor Neurological Examination
Bibliographic record
Abstract
BACKGROUND AND OBJECTIVES: Patients with traumatic subdural hematoma (SDH) and poor neurological presentation frequently experience adverse outcomes. Few studies investigate whether operative neurosurgical intervention is associated with favorable outcomes for these patients. The objective of this study was to measure associations between operative neurosurgery and favorable discharge in patients with traumatic SDH and poor neurological presentation. METHODS: This was a retrospective cohort study using the American College of Surgeons Trauma Quality Programs Dataset. In total, 13 393 adult patients (≥18 years) presenting with traumatic SDH, midline shift >5 mm, and Glasgow Coma Scale ≤8 were included. Risk-adjusted hierarchical regression models were specified to measure associations between operative neurosurgery and favorable discharge to home or inpatient rehabilitation. Effect modification by pupillary response (both [2R], one [1R] or neither reactive [0R]) was evaluated. Marginal effects of operative neurosurgery on favorable discharge probability were estimated across pupillary response and age subgroups. RESULTS: Patients with 0R pupils were least likely to undergo operative neurosurgery (0R, 34% vs 1R, 50% vs 2R, 50%; P < .001). After risk adjustment, operative neurosurgery was associated with favorable discharge (odds ratio, 1.93; 95% CI, 1.74-2.14). This association was significantly modified by pupillary response ( P for interaction, <0.001), with the greatest potential benefit observed for patients with 0R pupils (probability, 3.7% increased to 11.8%). Operative neurosurgery provided potential benefit across all age quartiles but declined significantly for the eldest patients (>75 years). CONCLUSION: Operative neurosurgical intervention is associated with favorable discharge among patients with traumatic SDH and poor neurological presentation. This was consistent across pupillary response and age subgroups, but potential benefit was reduced among the eldest patients.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".