The effect of time to neurosurgical or neuroradiological intervention therapy on outcomes after traumatic brain injury, a registry-based observational study

Abstract Background The evidence regarding the effect of time to neurosurgical and neuroradiological intervention on outcomes in traumatic brain injury (TBI) patients is still controversial. This study aimed to investigate the effect of time to hospital interventions on outcomes after TBI. Methods Adult TBI patients who received any neurosurgical or neuroradiological interventions during the year 2015-2022 in the Pan-Asian Trauma Outcome Study database were analyzed, excluding patients with unknown exposure information and unknown outcomes. The time to intervention, as the main exposure, was classified into three groups (Early, Intermediate, and Delayed) using the Restricted Cubic (RC) Spline analysis. The outcomes were in-hospital mortality and unfavorable neurological outcomes. W score was calculated to compare the quality of care among exposure groups. Multivariable logistic regression analysis and interaction analysis were performed to identify the association between the exposure groups and outcomes by calculating adjusted odds ratios (AOR) with 95% confidence intervals (CI). Results A total of 1,780 patients were included. From the RC Spline analysis, patients were classified into three groups according to time to intervention: Early (<1.9 h), Intermediate (1.9-4.1 h), and Delayed (>4.1 h). According to the time to intervention, W score was -8.6 in the early group, -1.1 in the intermediate group, and +0.4 in the delayed group. Patients receiving intermediate and delayed intervention had a significantly lower mortality (AOR 0.64, 95% CI 0.47-0.86 and AOR 0.66, 95%CI 0.48-0.90, respectively). Conclusion The early neurosurgical and neuroradiological interventions were associated with higher mortality in TBI patients, regardless of transportation modes. The quality of care should be focused and improved during the early hours of TBI.