The impact of time from ED arrival to surgery on mortality and hospital length of stay in patients with traumatic brain injury

J Emerg Nurs. 2011 Jul;37(4):328-33. doi: 10.1016/j.jen.2010.04.017. Epub 2010 Jun 11.


Introduction: The previous studies examining the benefits of timely surgery in patients with traumatic brain injury (TBI) have yielded inconsistent conclusions. This study examined how time from ED arrival to surgery in patients with TBI influenced two patient outcomes: hospital mortality and length of hospital stay.

Methods: Using a multivariate and cross-sectional research design, the study sample included 493 patients from the 17 level I and II trauma centers that met inclusion criteria in the National Trauma Data Bank 4.0. The patient characteristics (eg, age, Glasgow Coma Scale score, Injury Severity score, and ED arrival time) and trauma center characteristics (eg, ownership, designation type, and center level) were examined. Student t test, χ² test, analysis of variance, and multilevel regression models were used to analyze data.

Results: Patients who underwent craniotomy or drainage of hematoma within 4 hours of arrival had half the likelihood of mortality when compared with those who underwent surgery more than 4 hours after ED arrival (odds ratio = .49; 95% confidence interval = .24 to .99). When patients had surgery within 4 hours of arrival, they had a significantly shorter length of hospital stay than did patients who had surgery more than 4 hours after arrival in the emergency department (Estimate = -.10, 95% confidence interval = -.19 to -.01).

Discussion: Based on the results of this study using a large sample from multiple centers and advanced statistics, benefits of early clinical assessment and quick access to neurosurgical surgery are substantiated in patients with TBI.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Age Factors
  • Aged
  • Brain Injuries / surgery*
  • Cross-Sectional Studies
  • Female
  • Glasgow Coma Scale
  • Hospital Mortality*
  • Humans
  • Length of Stay / statistics & numerical data*
  • Male
  • Middle Aged
  • Odds Ratio
  • Severity of Illness Index
  • Time Factors
  • Trauma Centers / statistics & numerical data*
  • Young Adult