Abstract

Summary

To evaluate the effectiveness of optimizing indications for simultaneous operations in patients with combined traumatic brain injury (cTBI).
 

Materials and Methods

A non-randomized comparative clinical study was conducted, in-cluding 168 patients aged 18-60 years with cTBI. Depending on the chosen treatment strategy, pa-tients were allocated into two groups: the main group (treated using simultaneous operations based on optimized indications) and the control group (treated using conventional indications for simultaneous operations). Patient status was assessed using the Glasgow Coma Scale (GCS), the Gumanenko Severity of Condition Scale, and the Nazarenko Injury Severity Scale. The nature and timing of surgical procedures, cTBI outcomes, the rate of severe unfavorable outcomes, and long-term fracture healing results were analyzed.
 

Results

Optimization of indications for simultaneous operations led to a statistically sig-nificant change in surgical strategy: the main group more frequently underwent emergency and heterogeneous simultaneous interventions, including the combination of intracranial injury cor-rection with primary surgical wound debridement and fracture osteosynthesis. In the main group, the proportion of good recovery was higher than in the control group, whereas the rate of severe unfavorable outcomes (severe disability, vegetative state, death) was lower. The risk of severe un-favorable outcomes in the main group was reduced by 46% (OR=0.41; 95% CI: 0.21-0.80; p=0.007), and the likelihood of favorable outcomes was higher (OR=1.94; 95% CI: 1.04-3.62; p=0.038). Mortality rates increased with greater injury severity according to the Glasgow Coma Scale, the Gumanenko Scale, and the Nazarenko Scale. Long-term fracture outcomes were also better in the main group: the mean SOI-1 score was 87.6±2.3 compared to 81.4±1.9 in the control group (p<0.0001).
 

Conclusion

The use of optimized indications for simultaneous operations in patients with cTBI allows a shift in surgical strategy toward more comprehensive and timely interventions and is associated with improved clinical outcomes, a lower rate of severe unfavorable outcomes, and better long-term fracture healing results. When selecting the optimal surgical strategy, it is advis-able to consider not only the clinical presentation but also objective scales assessing injury sever-ity and patient condition.
 

Keywords

combined traumatic brain injury simultaneous operations surgical strategy treatment outcomes mortality osteosynthesis.

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