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Outcome of patients with severe brain trauma who were treated either by neurosurgeons or by trauma surgeons

Leitgeb, Johannes MD; Mauritz, Walter MD, PhD; Brazinova, Alexandra MD, PhD, MPH; Matula, Christian MD, PhD; Majdan, Marek PhD; Wilbacher, Ingrid MSc, PhD; Rusnak, Martin CSc, MD, PhD

Journal of Trauma and Acute Care Surgery: May 2012 - Volume 72 - Issue 5 - p 1263–1270
doi: 10.1097/TA.0b013e318248ed83
Original Articles

BACKGROUND: In Central Europe, patients with severe traumatic brain injury (TBI) are frequently treated by trauma surgeons rather than neurosurgeons. The objective of this study was to compare outcomes of patients with TBI by trauma surgeons or neurosurgeons. This study is a retrospective analysis of prospectively collected data.

METHODS: Between January 2001 and December 2005, 10 centers enrolled 311 operatively treated patients with severe TBI and no significant other injuries into observational studies. Data on accident, treatment, and outcomes were collected. Using the Glasgow Outcome Scale, 1-year outcomes were classified as “favorable” (scores 5 and 4) or “unfavorable” (scores <4). Data from patients operated by trauma surgeons (“group T”) were compared with those from patients operated by neurosurgeons (“group N”) using univariate and multivariate statistics. The scores published by Hukkelhoven et al. were used to estimate expected rates of death and unfavorable outcomes.

RESULTS: There were 191 patients in group N and 120 in group T. There were no significant differences regarding age, sex, and trauma mechanisms between the two groups. Patients from group N had significantly higher trauma severity. The observed versus expected hospital mortality ratio was 0.84 for group N and 0.97 for group T (p = 0.051). One-year outcome was better in group T (28% vs. 19% good recovery, 1.7% vs. 9.4% vegetative status; p = 0.017), whereas mortality was not different (43% in both groups). Multivariate analysis revealed that outcomes were influenced by age and severity of TBI, whereas surgical specialty and treatment factors had no effects.

CONCLUSION: With respect to operatively treated patients with TBI, trauma surgeons and neurosurgeons achieve comparable results.

LEVEL OF EVIDENCE: II.

Vienna, Austria

From the Departments of Traumatology (J.L.) and Neurosurgery (C.M.), Medical University of Vienna; Trauma Hospital “Lorenz Boehler” (W.M.); International Neurotrauma Research Organization (INRO) (W.M., A.B., M.M., I.W., M.R.), Vienna, Austria; and Department of Public Health (A.B., M.R.), Faculty of Health and Social Services, Trnava University, Slovak Republic.

Submitted: October 8, 2011, Revised: December 21, 2011, Accepted: December 29, 2011.

The data used for this study were collected for a project funded by an European Union grant (Project “Research-Treat-TBI”; 6th Framework Program: INCO-DEV: International Cooperation with Developing Countries 1998–2002; Contract number: ICA2-CT-2002-100) and for another project funded by the Austrian Worker's Compensation Board (AUVA; Contract number FK 33/2003) and by the “Jubilee Fund” of the Austrian National Bank (Project number 8987). The International Neurotrauma Research Organization, a tax-exempt Austrian non-governmental organization, is supported by an annual grant from Mrs. Ala Auersperg-Isham and Mr. Ralph Isham, and by small donations from various sources.

Address for reprints: Johannes Leitgeb, MD, Department of Traumatology, Medical University of Vienna, Währinger Gürtel 18-20, Vienna A-1090, Austria; email: johannes.leitgeb@meduniwien.ac.at.

© 2012 Lippincott Williams & Wilkins, Inc.