Time from injury to operative intervention in traumatic intracranial hematoma: A systematic literature review and meta-analysis.

Abstract

The outcomes in traumatic intracranial hematoma (TICH) have not improved significantly despite advances in trauma care. A modifiable factor in TICH management is time to operation room (T_OR). T_OR has become a key marker in Traumatic brain injury care despite a lack of contemporary evidence. This study aimed to determine the timing of TICH evacuation and its association with mortality and neurological outcomes. A systematic review of PubMed, OVID MEDLINE, CINAHL, and Web of Science. Included studies reported data on adult patients with acute TICH who underwent surgical evacuation. The primary outcome was T_OR and its association with mortality or functional neurological recovery. From 1838 articles screened, 17 were included. Eight studies reported T_OR as a continuous variable, ranging between 3 and 7.1 h. Three studies found better outcomes with shorter T_OR, five found no difference, and one found worse outcomes with shorter T_OR. Five articles were included in meta-analysis of mortality in patients undergoing operative decompression less than or greater than 4 h from injury which found lower mortality in the >4-h group, OR = 1.53. Longitudinal regression analysis showed no difference in T_OR over the 33-year span of articles included. There is limited data available on T_OR in TICH, with equivocal results on the effect of timing on outcomes. T_OR has not decreased over the last 4 decades. The unvalidated 4-h cut-off seems to be associated with better survival. Contemporary assessment of this potentially important performance indicator is required.