Background: Pediatric neurosurgeons are occasionally tasked with performing surgery expeditiously to preserve a child’s neurologic faculties and life. Objective: This study examines the etiologies, outcomes, and costs for urgent or emergent craniotomies at a Level I Pediatric Trauma center over a 7-year time period. Methods: A retrospective review was conducted for each patient who underwent an emergent or urgent craniotomy within 24 hours of presentation between January 2010 and April 2017. Demographic, clinical, and surgical details were recorded for a total of 48 variables. Any readmission within 90 days was analyzed. Hospital charges for each admission and readmission were collected and adjusted for inflation to October 2018 values. Results: Among the 223 children who underwent urgent or emergent craniotomies, the majority were admitted for traumatic injuries (n = 163, 73.1%). The most common traumatic mechanism was fall (n = 51, 22.9%), and the most common non-traumatic cause was tumor (n = 21, 9.4%). Overall, craniotomies were typically performed for hematoma evacuation of one type or combination (n = 115, 51.6%) during off-peak times (n = 178, 79.8%). Seventy-seven (34.5%) subjects experienced 1 or more postoperative events, 22 of whom returned to the operating room. There were 13 (5.8%) and 33 (14.8%) readmissions within 30 days and 90 days of discharge, respectively. Non-trauma patients (compared with trauma patients) and polytrauma (compared with isolated head injury) had greater healthcare needs, resulting in higher charges. Conclusion: Most urgent or emergent pediatric craniotomies were performed for the treatment of traumatic injuries involving hematoma evacuation, but non-traumatic patients were more complex requiring greater resources.

1.
Bishop
NB
.
Traumatic brain injury: a primer for primary care physicians
.
Curr Probl Pediatr Adolesc Health Care
.
2006
Oct
;
36
(
9
):
318
31
.
[PubMed]
1538-5442
2.
von Lehe
M
,
Kim
HJ
,
Schramm
J
,
Simon
M
:
A comprehensive analysis of early outcomes and complication rates after 769 craniotomies in pediatric patients.
Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery
2013
;29:781-790.
3.
Adamo
MA
,
Drazin
D
,
Waldman
JB
.
Decompressive craniectomy and postoperative complication management in infants and toddlers with severe traumatic brain injuries
.
J Neurosurg Pediatr
.
2009
Apr
;
3
(
4
):
334
9
.
[PubMed]
1933-0707
4.
Kan
P
,
Amini
A
,
Hansen
K
,
White
GL
 Jr
,
Brockmeyer
DL
,
Walker
ML
, et al
Outcomes after decompressive craniectomy for severe traumatic brain injury in children
.
J Neurosurg
.
2006
Nov
;
105
(
5
Suppl
):
337
42
.
[PubMed]
0022-3085
5.
Malmivaara
K
,
Kivisaari
R
,
Hernesniemi
J
,
Siironen
J
.
Cost-effectiveness of decompressive craniectomy in traumatic brain injuries
.
Eur J Neurol
.
2011
Apr
;
18
(
4
):
656
62
.
[PubMed]
1351-5101
6.
Desgranges
FP
,
Javouhey
E
,
Mottolese
C
,
Migeon
A
,
Szathmari
A
,
Baudin
F
,
de Queiroz
M
,
Cogniat
B
,
Chassard
D
:
Intraoperative blood loss during decompressive craniectomy for intractable intracranial hypertension after severe traumatic brain injury in children.
Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery
2014
;30:1393-1398.
7.
Pérez Suárez
E
,
Serrano González
A
,
Pérez Díaz
C
,
García Salido
A
,
Martínez de Azagra Garde
A
,
Casado Flores
J
.
Decompressive craniectomy in 14 children with severe head injury: clinical results with long-term follow-up and review of the literature
.
J Trauma
.
2011
Jul
;
71
(
1
):
133
40
.
[PubMed]
0022-5282
8.
De Vloo
P
,
Nijs
S
,
Verelst
S
,
van Loon
J
,
Depreitere
B
.
Prehospital and intrahospital temporal intervals in patients requiring emergent trauma craniotomy. A 6-year observational study in a level 1 trauma center
.
World Neurosurg
.
2018
Jun
;
114
:
e546
58
.
[PubMed]
1878-8750
9.
Matsushima
K
,
Inaba
K
,
Siboni
S
,
Skiada
D
,
Strumwasser
AM
,
Magee
GA
, et al
Emergent operation for isolated severe traumatic brain injury: does time matter?
J Trauma Acute Care Surg
.
2015
Nov
;
79
(
5
):
838
42
.
[PubMed]
2163-0755
10.
Miner
ME
,
Kaufman
HH
,
Graham
SH
,
Haar
FH
,
Gildenberg
PL
.
Disseminated intravascular coagulation fibrinolytic syndrome following head injury in children: frequency and prognostic implications
.
J Pediatr
.
1982
May
;
100
(
5
):
687
91
.
[PubMed]
0022-3476
11.
Brown
CV
,
Foulkrod
KH
,
Lopez
D
,
Stokes
J
,
Villareal
J
,
Foarde
K
, et al
Recombinant factor VIIa for the correction of coagulopathy before emergent craniotomy in blunt trauma patients
.
J Trauma
.
2010
Feb
;
68
(
2
):
348
52
.
[PubMed]
0022-5282
12.
Veshchev
I
,
Elran
H
,
Salame
K
.
Recombinant coagulation factor VIIa for rapid preoperative correction of warfarin-related coagulopathy in patients with acute subdural hematoma
.
Med Sci Monit
.
2002
Dec
;
8
(
12
):
CS98
100
.
[PubMed]
1234-1010
13.
Linzey
JR
,
Burke
JF
,
Sabbagh
MA
,
Sullivan
S
,
Thompson
BG
,
Muraszko
KM
, et al
The effect of surgical start time on complications associated with neurological surgeries
.
Neurosurgery
.
2018
Sep
;
83
(
3
):
501
7
.
[PubMed]
0148-396X
14.
McCrory
MC
,
Gower
EW
,
Simpson
SL
,
Nakagawa
TA
,
Mou
SS
,
Morris
PE
.
Off-hours admission to pediatric intensive care and mortality
.
Pediatrics
.
2014
Nov
;
134
(
5
):
e1345
53
.
[PubMed]
0031-4005
15.
Wright
MC
,
Phillips-Bute
B
,
Mark
JB
,
Stafford-Smith
M
,
Grichnik
KP
,
Andregg
BC
, et al
Time of day effects on the incidence of anesthetic adverse events
.
Qual Saf Health Care
.
2006
Aug
;
15
(
4
):
258
63
.
[PubMed]
1475-3898
16.
Borgman
M
,
Matos
RI
,
Blackbourne
LH
,
Spinella
PC
.
Ten years of military pediatric care in Afghanistan and Iraq
.
J Trauma Acute Care Surg
.
2012
Dec
;
73
(
6
Suppl 5
):
S509
13
.
[PubMed]
2163-0755
17.
Burnett
MW
,
Spinella
PC
,
Azarow
KS
,
Callahan
CW
.
Pediatric care as part of the US Army medical mission in the global war on terrorism in Afghanistan and Iraq, December 2001 to December 2004
.
Pediatrics
.
2008
Feb
;
121
(
2
):
261
5
.
[PubMed]
0031-4005
18.
Creamer
KM
,
Edwards
MJ
,
Shields
CH
,
Thompson
MW
,
Yu
CE
,
Adelman
W
.
Pediatric wartime admissions to US military combat support hospitals in Afghanistan and Iraq: learning from the first 2,000 admissions
.
J Trauma
.
2009
Oct
;
67
(
4
):
762
8
.
[PubMed]
0022-5282
19.
Edwards
MJ
,
Lustik
M
,
Burnett
MW
,
Eichelberger
M
.
Pediatric inpatient humanitarian care in combat: iraq and Afghanistan 2002 to 2012
.
J Am Coll Surg
.
2014
May
;
218
(
5
):
1018
23
.
[PubMed]
1072-7515
20.
Klimo
P
 Jr
,
Ragel
BT
,
Scott
WH
 Jr
,
McCafferty
R
.
Pediatric neurosurgery during operation enduring freedom
.
J Neurosurg Pediatr
.
2010
Aug
;
6
(
2
):
107
14
.
[PubMed]
1933-0707
21.
Martin
JE
,
Teff
RJ
,
Spinella
PC
.
Care of pediatric neurosurgical patients in Iraq in 2007: clinical and ethical experience of a field hospital
.
J Neurosurg Pediatr
.
2010
Sep
;
6
(
3
):
250
6
.
[PubMed]
1933-0707
22.
Mauer
UM
,
Freude
G
,
Schulz
C
,
Kunz
U
,
Mathieu
R
.
Pediatric neurosurgical care in a german field hospital in afghanistan
.
J Neurol Surg A Cent Eur Neurosurg
.
2017
Jan
;
78
(
1
):
20
4
.
[PubMed]
2193-6323
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.