Abstract Details

Title Endovascular and Surgical Treatment of Subarachnoid Hemorrhage Patients in Trauma Setting: Analysis from National Trauma Data Base (NTDB)

Topic Critical Care/Emergency Neurology/Trauma

Presentation(s) P01 - (-)

Poster/Presentation
Number 028

Objective

Background Traumatic subarachnoid hemorrhage (tSAH) occurs in up to 60% of patients with TBI and is associated with higher death and disability in TBI patients. Vascular injury in the form of aneurysms, dissections, and transections may require treatment to prevent further bleeding episodes.

Design/Methods tSAH and related endovascular and surgical procedures were identified by ICD-9-CM codes from the National Trauma Data Bank (NTDB). NTDB represents one of the largest trauma databases and contains data from over 900 trauma centers across the United States. Surgical and endovascular treatment groups were compared by variables of patient demographics, initial injury severity score (ISS) and GCS assessment in the emergency department (ED), hospital course, and treatment outcomes.

Results A total of 119 tSAH patients were identified who required treatment for intracranial vascular injury. Of these, 53% received endovascular treatment and 47% were treated surgically. The mean Injury Severity Score (ISS) [23(19-26) versus 15(12-18); P=0.03] and frequency of skull base fracture (30% versus 2%; P<.0001) were significantly higher in the endovascular treated group than in surgical group. Admission GCS scores were also significantly lower in the endovascular treated group (P=0.007). ICU days in the endovascular treatment group were significantly lower than in the surgical group [14(10-17) versus 16(13-17); P=0.04]. ICU days remained significantly lower in the endovascular group after adjusting for admission GCS, ISSAIS, skull base fracture, and other characteristics [0.4 (0.2-0.8); P=0.009]. Although the mean length of hospital stay was 3 days less in the endovascular group, this difference was not statistically significant.

Conclusions Despite more severe injury and lower admission GCS scores, patients who received endovascular treatment had lower ICU day requirement and similar discharge outcomes. Such observations support the preferential use of endovascular treatment in trauma settings.

Authors/Disclosures
Shahram Majidi, MD (Icahn School of Medicine at Mount Sinai) PRESENTER	Dr. Majidi has nothing to disclose.
Vikram Jadhav, MD (Minnesota Stroke Network)	No disclosure on file
	No disclosure on file
Elizabeth M. Berry-Kravis, MD, PhD (Rush University Medical Center)	The institution of Dr. Berry-Kravis has received research support from NIH. The institution of Dr. Berry-Kravis has received research support from Ionis. The institution of Dr. Berry-Kravis has received research support from Zynerba. The institution of Dr. Berry-Kravis has received research support from Roche. The institution of Dr. Berry-Kravis has received research support from CDC. The institution of Dr. Berry-Kravis has received research support from FRAXA Research Foundation. The institution of Dr. Berry-Kravis has received research support from GeneTx. The institution of Dr. Berry-Kravis has received research support from Angelman Syndrome Foundation. The institution of Dr. Berry-Kravis has received research support from Acadia. The institution of Dr. Berry-Kravis has received research support from Ultragenyx. The institution of Dr. Berry-Kravis has received research support from Mallinckrodt. The institution of Dr. Berry-Kravis has received research support from Together Strong Foundation. The institution of Dr. Berry-Kravis has received research support from Zevra. The institution of Dr. Berry-Kravis has received research support from Taysha. The institution of Dr. Berry-Kravis has received research support from Tetra. The institution of Dr. Berry-Kravis has received research support from Neuren.
Basit Rahim, MD (Virginia Commonwealth University Health System)	No disclosure on file
Masaki Watanabe (University of Minnesota)	No disclosure on file
Hamza I. Maqsood, MD (Dept of Neurology)	Dr. Qureshi has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for AstraZeneca.

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