This was a retrospective observational study that used data of emergency trauma patients registered in the JTDB. With the use of data from the JTDB registry, the aim of this study was to evaluate the association between the occurrence of posttraumatic meningitis and factors such as patient characteristics, type of surgery, and procedures performed during the surgery among the traumatic head injury patients with head AIS score 3 or more. Data registration in the JTDB was launched in 2003, and approximately 230,000 emergency trauma patients were enrolled by 2015. The Japanese Trauma Data Bank (JTDB) is a nationwide trauma registry in Japan that is managed by The Japanese Association for The Surgery of Trauma. However, it is unclear whether burr hole surgery performed in the emergency department, the procedures performed during the neurosurgical operation and repeat surgery are associated with posttraumatic meningitis in patients with traumatic head injury. Thus, burr hole surgery is sometimes performed in the emergency department for some patients, and decompressive craniectomy for patients with traumatic brain injury and refractory intracranial hypertension has resulted in a favorable neurological outcome. In addition, it may take time to prepare a hospital operating room when an emergency operation is required for severe head injury patients. If it takes time to transport severe trauma patients from areas, where there are no neurosurgeons to distant medical institutions, their prognosis would become worse. In addition, the length of time of external ventricular drainage, emergency operation, and operation time over 4.5 h was also reported to relate to the occurrence of postoperative meningitis in patients undergoing a neurosurgical operation. Previous studies revealed that basilar skull fracture and cerebrospinal fluid (CSF) leakage were also associated with posttraumatic meningitis. There are reports about high mortality rates from 29% to 57.9% due to this infection. Meningitis can be a severe complication with a negative influence on the outcome after craniocerebral trauma. In addition, many head injury survivors have a poor neurological outcome due to diffuse axonal injury. Head injury occurs in about 25% of trauma patients in Japan, and mortality remains high. In this population of trauma patients, burr hole surgery in the emergency department and decompressive craniectomy was associated with posttraumatic meningitis. Factors associated with posttraumatic meningitis were burr hole surgery in the emergency department (adjusted odds ratio 2.158 ), decompressive craniectomy (AOR 2.123 ), external ventricular drainage (AOR 1.843 ), CSF leakage (AOR 3.328 ), and basilar skull fracture (AOR 1.651 ). ResultsĪmong 60,390 head injury patients with head AIS score 3 or more, 284 (0.5%) patients had posttraumatic meningitis. ![]() Multivariable logistic regression analysis was used to assess independent parameters associated with posttraumatic meningitis such as CSF fistula, burr hole surgery in the emergency department, and decompressive craniectomy. The main endpoint was the occurrence of meningitis during hospitalization. We included trauma patients registered in the Japanese Trauma Data Bank, whose head Abbreviated Injury Scale score was ≥ 3 in this study. This was a retrospective observational study with a 12-year study period from January 2004 to December 2015. The aim of this study was to assess factors associated with posttraumatic meningitis with a nationwide hospital-based trauma registry in Japan. However, it remains unclear whether procedures such as burr hole surgery in the emergency department and decompressive craniectomy are associated with posttraumatic meningitis. Factors such as cerebrospinal fluid (CSF) fistula and basilar skull fracture are associated with posttraumatic meningitis. Posttraumatic meningitis is one of the severe complications that can result in increased mortality and longer hospital stay among trauma patients.
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