Why Mortality Is Still High with Modern Care of 613 Evacuated Mass Lesions Presented as Severe Head Injuries 1999–2009

Abstract

Of 1,949 successive acute severe head injuries (SHI) over a period of 11 years 1999–2009, 613 (31.5%) underwent evacuation of mass lesions. Mortality at 3 months of evacuated mass (EM) lesions was higher over 10 years compared with that of non-EM lesions (it was overall 22%). The reduction of mortality was significantly less in EM compared with that for non-surgical cases (14.4–9.4% recently) and for the cases that were operated but not for mass evacuation (18.1–12.1%). A few explanations are: first, more SDH (60.5% of the EM recently compared with 45.9% in the first few years); second, more severe cases and older patients with co-morbidities were treated surgically; third, advances in prehospital care brought more severe patients to operative care – the rate of referrals decreased from 61.5% to 52.8% recently; fourth, part of the significant shortening of the injury to NT admission time (163–141 min) vanished owing to the parallel elongation of admission to operation time (95–100 min), thus, the threshold recommendation of 4 h to mass evacuation was achieved in only 52%; fifth, introducing decompressive craniectomy was not associated with outcome improvement.