Impact of Early Decompressive Craniectomy Following Blunt Traumatic Brain Injury on Mortality: Propensity Matched Analysis.

Background  The purpose of this study was to evaluate the impact of the early craniectomy on mortality. Hypothesis  Early craniectomy within 4 hours of hospital arrival will reduce in-hospital mortality. Methods  Data were retrieved from the National Trauma Data Bank data set (RDS_2007-RDS_2010). All craniectomies performed on patients with a blunt mechanism of head injury within 24 hours of admission were included in the study. In-hospital mortality was the main outcome of interest. Results  A total of 942 patients qualified for the study. Overall, 669 patients (71%) underwent a craniectomy within 4 hours (early group), and 273 patients (29%) had a craniectomy performed between > 4 hours to 24 hours following hospital arrival (late group). Propensity matched analysis identified 268 pairs of patients in both groups. The mean standardized differences were < 10% after matching. There were no significant differences in mortality (odds ratio: 1.018; confidence interval [CI], 0.689-1.506; p  = 1.00), absolute risk reduction (0.004; 95% CI, - 0.078 to 0.085; p  = 1.00), and length of stay (LOS) between the groups (hazard ratio: 0.770; 95% CI, 0.56-1.059; p  = 0.108). Conclusion  No differences were seen on in-hospital mortality and hospital LOS between patients operated within 4 hours versus patients operated between 4 and 24 hours of admission.