{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T07:41:25Z","timestamp":1782891685036,"version":"3.54.5"},"reference-count":39,"publisher":"Oxford University Press (OUP)","issue":"9-10","license":[{"start":{"date-parts":[[2022,1,17]],"date-time":"2022-01-17T00:00:00Z","timestamp":1642377600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,8,25]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n               <jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>To date, there is no evidence concerning the emergency surgical management of severe trauma patients (STP) with severe traumatic brain injury (STBI) presenting a life-threatening intracranial hematoma and a concomitant extra-cranial noncompressible active bleeding. Current guidelines recommend stopping the extra-cranial bleeding first. Nevertheless, the long-term outcome of STP with STBI mainly depends from intracranial lesions. Thus, we propose a combined damage-control surgical strategy aiming to reduce the time spent with intracranial hypertension and to hasten the admission in the intensive care unit. The main objective of the study is to evaluate the benefits of combined cranial and extra-cranial surgery of STP on the long-term outcome.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Materials and Methods<\/jats:title>\n                  <jats:p>We retrospectively searched through the database of STBI of a level 1 trauma center facility (Sainte-Anne Military Teaching Hospital, Toulon, France) from 2007 until 2021 looking for patients who benefited from combined cranial and extra-cranial surgery in an acute setting.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>The research yielded 8 patients. The mean age was 35\u2009years old (\u00b114) and the male to female sex ratio was 1.7\/1. The trauma mechanism was a fall in 50% of the cases and a traffic accident in 50% of the cases. The median Glasgow coma scale score was 8 (IQR 4) before intubation. The median Injury Severity Score was 41 (IQR 16). Seven patients (88%) presented hypovolemic shock upon admission. Six patients (75%) benefited from damage-control laparotomy among, whom 4 (67%) underwent hemostatic splenectomy. One patient benefited from drainage of tension pneumothorax, and one patient benefited from external fixator of multiple limb fractures. Seven patients (88%) benefited from decompressive craniectomy for acute subdural hematoma (5 patients) or major brain contusion (2 patients). One patient (12%) benefited from craniotomy for epidural hematoma. Three patients presented intraoperative profound hypovolemic shock. Six patients (75%) presented a favorable neurologic outcome with minor complications from extra-cranial surgeries and 2 patients died (25%).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Performing combined life-saving cranial and extra-cranial surgery is feasible and safe as long as the trauma teams are trained according to the principles of damage control. It may be beneficial for the neurologic prognostic of STP with STBI requiring cranial and extra-cranial surgery.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/milmed\/usab555","type":"journal-article","created":{"date-parts":[[2022,1,17]],"date-time":"2022-01-17T23:49:10Z","timestamp":1642463350000},"page":"1127-1135","source":"Crossref","is-referenced-by-count":16,"title":["Severe Trauma Patients Requiring Undelayable Combined Cranial and Extra-Cranial Surgery: A Proof-of-Concept Monocentric Study"],"prefix":"10.1093","volume":"187","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3047-4234","authenticated-orcid":false,"given":"Nathan","family":"Beucler","sequence":"first","affiliation":[{"name":"Neurosurgery Department, Sainte-Anne Military Teaching Hospital , Toulon, Provence-Alpes-C\u00f4te d\u2019Azur 83800, France"},{"name":"Ecole du Val-de-Gr\u00e2ce, French Military Health Service Academy , Paris, Ile-de-France 75230, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aurore","family":"Sellier","sequence":"additional","affiliation":[{"name":"Neurosurgery Department, Sainte-Anne Military Teaching Hospital , Toulon, Provence-Alpes-C\u00f4te d\u2019Azur 83800, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christophe","family":"Joubert","sequence":"additional","affiliation":[{"name":"Neurosurgery Department, Sainte-Anne Military Teaching Hospital , Toulon, Provence-Alpes-C\u00f4te d\u2019Azur 83800, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C\u00e9dric","family":"Bernard","sequence":"additional","affiliation":[{"name":"Neurosurgery Department, Sainte-Anne Military Teaching Hospital , Toulon, Provence-Alpes-C\u00f4te d\u2019Azur 83800, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicolas","family":"Desse","sequence":"additional","affiliation":[{"name":"Neurosurgery Department, Sainte-Anne Military Teaching Hospital , Toulon, Provence-Alpes-C\u00f4te d\u2019Azur 83800, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pierre","family":"Esnault","sequence":"additional","affiliation":[{"name":"Intensive Care Unit, Sainte-Anne Military Teaching Hospital , Toulon, Provence-Alpes-C\u00f4te d\u2019Azur 83800, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arnaud","family":"Dagain","sequence":"additional","affiliation":[{"name":"Neurosurgery Department, Sainte-Anne Military Teaching Hospital , Toulon, Provence-Alpes-C\u00f4te d\u2019Azur 83800, France"},{"name":"Val-de-Gr\u00e2ce Military Academy , Paris, Ile-de-France 75230, France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2022,1,17]]},"reference":[{"key":"2022082610283278500_R1","doi-asserted-by":"crossref","DOI":"10.1186\/s13017-019-0270-1","article-title":"WSES consensus conference guidelines: monitoring and management of severe adult traumatic brain injury patients with polytrauma in the first 24 hours","volume":"14","author":"Picetti","year":"2019","journal-title":"World J Emerg Surg"},{"issue":"2","key":"2022082610283278500_R2","doi-asserted-by":"crossref","first-page":"196","DOI":"10.1016\/j.injury.2011.06.029","article-title":"AIS&gt;2 in at least two body regions: a potential new anatomical definition of polytrauma","volume":"43","author":"Butcher","year":"2012","journal-title":"Injury"},{"issue":"3","key":"2022082610283278500_R3","doi-asserted-by":"crossref","first-page":"375","DOI":"10.1097\/00005373-199309000-00008","article-title":"\u201cDamage control\u201d: an approach for improved survival in exsanguinating penetrating abdominal injury","volume":"35","author":"Rotondo","year":"1993","journal-title":"J Trauma"},{"issue":"1","key":"2022082610283278500_R4","doi-asserted-by":"crossref","DOI":"10.1186\/s40560-016-0197-5","article-title":"Damage control resuscitation: a practical approach for severely hemorrhagic patients and its effects on trauma surgery","volume":"5","author":"Mizobata","year":"2017","journal-title":"J Intensive Care"},{"issue":"2","key":"2022082610283278500_R5","doi-asserted-by":"crossref","first-page":"250","DOI":"10.1093\/bja\/aeu203","article-title":"Damage control radiology in the severely injured patient: what the anaesthetist needs to know","volume":"113","author":"Chakraverty","year":"2014","journal-title":"Br J Anaesth"},{"issue":"supplement1","key":"2022082610283278500_R6","article-title":"VII. Intracranial pressure monitoring technology","volume":"24","author":"Bratton","year":"2007","journal-title":"J Neurotrauma"},{"issue":"1","key":"2022082610283278500_R7","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1227\/NEU.0000000000001432","article-title":"Guidelines for the management of severe traumatic brain injury, fourth edition","volume":"80","author":"Carney","year":"2017","journal-title":"Neurosurgery"},{"issue":"10","key":"2022082610283278500_R8","doi-asserted-by":"crossref","first-page":"1683","DOI":"10.1007\/s00701-015-2512-7","article-title":"Epidemiology of traumatic brain injury in Europe","volume":"157","author":"Peeters","year":"2015","journal-title":"Acta Neurochir (Wien)"},{"issue":"suppl_2","key":"2022082610283278500_R9","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1093\/milmed\/usy071","article-title":"Neurosurgery and medical management of severe head injury","volume":"183","author":"McCafferty","year":"2018","journal-title":"Mil Med"},{"issue":"3Suppl","key":"2022082610283278500_R10","first-page":"S7","article-title":"Surgical management of acute epidural hematomas","volume":"58","author":"Bullock","year":"2006","journal-title":"Neurosurgery"},{"issue":"3Suppl","key":"2022082610283278500_R11","first-page":"S16","article-title":"Surgical management of acute subdural hematomas","volume":"58","author":"Bullock","year":"2006","journal-title":"Neurosurgery"},{"issue":"2","key":"2022082610283278500_R12","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1016\/j.accpm.2015.06.013","article-title":"Vittel criteria for severe trauma triage: characteristics of over-triage","volume":"35","author":"Cotte","year":"2016","journal-title":"Anaesth Crit Care Pain Med"},{"issue":"1","key":"2022082610283278500_R13","doi-asserted-by":"crossref","DOI":"10.1186\/s12873-021-00476-6","article-title":"Prehospital time and mortality in polytrauma patients: a retrospective analysis","volume":"21","author":"Berkeveld","year":"2021","journal-title":"BMC Emerg Med"},{"issue":"8","key":"2022082610283278500_R14","doi-asserted-by":"crossref","first-page":"1440","DOI":"10.1016\/j.injury.2019.06.024","article-title":"Older polytrauma: mortality and complications","volume":"50","author":"de Vries","year":"2019","journal-title":"Injury"},{"issue":"5","key":"2022082610283278500_R15","doi-asserted-by":"crossref","first-page":"1047","DOI":"10.1016\/j.injury.2016.11.023","article-title":"Coagulopathy and transfusion requirements in war related penetrating traumatic brain injury. A single centre study in a French role 3 medical treatment facility in Afghanistan","volume":"48","author":"Bordes","year":"2017","journal-title":"Injury"},{"issue":"9","key":"2022082610283278500_R16","doi-asserted-by":"crossref","first-page":"907","DOI":"10.1016\/j.injury.2009.05.006","article-title":"Patterns of mortality and causes of death in polytrauma patients\u2014has anything changed?","volume":"40","author":"Pfeifer","year":"2009","journal-title":"Injury"},{"issue":"5","key":"2022082610283278500_R17","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1016\/0020-1383(95)00223-5","article-title":"Outcome after acute extradural haematoma, influence of additional injuries and neurological complications in the ICU","volume":"27","author":"Heinzelmann","year":"1996","journal-title":"Injury"},{"issue":"6","key":"2022082610283278500_R18","doi-asserted-by":"crossref","first-page":"1116","DOI":"10.1097\/00003246-200106000-00004","article-title":"Secondary insults in severe head injury\u2014do multiply injured patients do worse?","volume":"29","author":"Sarrafzadeh","year":"2001","journal-title":"Crit Care Med"},{"issue":"9","key":"2022082610283278500_R19","doi-asserted-by":"crossref","first-page":"393","DOI":"10.2176\/nmc.oa.2018-0116","article-title":"Outcomes after traumatic brain injury with concomitant severe extracranial injuries","volume":"58","author":"Watanabe","year":"2018","journal-title":"Neurol Med Chir(Tokyo)"},{"issue":"7","key":"2022082610283278500_R20","doi-asserted-by":"crossref","first-page":"1639","DOI":"10.7150\/ijms.54913","article-title":"Clinical predictors of prognosis in patients with traumatic brain injury combined with extracranial trauma","volume":"18","author":"Liu","year":"2021","journal-title":"Int J Med Sci"},{"issue":"25","key":"2022082610283278500_R21","doi-asserted-by":"crossref","first-page":"1511","DOI":"10.1056\/NEJM198106183042503","article-title":"Traumatic acute subdural hematoma: major mortality reduction in comatose patients treated within four hours","volume":"304","author":"Seelig","year":"1981","journal-title":"N Engl J Med"},{"issue":"3","key":"2022082610283278500_R22","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1097\/00005373-199209000-00011","article-title":"The deleterious effects of intraoperative hypotension on outcome in patients with severe head injuries","volume":"33","author":"Pietropaoli","year":"1992","journal-title":"J Trauma"},{"issue":"6","key":"2022082610283278500_R23","first-page":"431","article-title":"Prise en charge des traumatis\u00e9s cr\u00e2niens graves \u00e0 la phase pr\u00e9coce (24 premi\u00e8res heures)","volume":"2","author":"Geeraerts","year":"2016","journal-title":"Anesth Reanim"},{"issue":"1","key":"2022082610283278500_R24","first-page":"62","article-title":"Recommandations sur la r\u00e9animation du choc h\u00e9morragique","volume":"1","author":"Duranteau","year":"2015","journal-title":"Anesth Reanim"},{"issue":"3","key":"2022082610283278500_R25","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1007\/s00117-019-00633-w","article-title":"Update polytrauma and computed tomography in ongoing resuscitation : ABCDE and \u201cdiagnose first what kills first\u201d","volume":"60","author":"G\u00e4ble","year":"2020","journal-title":"Radiologe"},{"issue":"9673","key":"2022082610283278500_R26","doi-asserted-by":"crossref","first-page":"1455","DOI":"10.1016\/S0140-6736(09)60232-4","article-title":"Effect of whole-body CT during trauma resuscitation on survival: a retrospective, multicentre study","volume":"373","author":"Huber-Wagner","year":"2009","journal-title":"Lancet"},{"issue":"Suppl 1","key":"2022082610283278500_R27","doi-asserted-by":"crossref","first-page":"S61","DOI":"10.1016\/j.jviscsurg.2017.09.004","article-title":"Resuscitation thoracotomy-technical aspects","volume":"154","author":"De Lesquen","year":"2017","journal-title":"J Visc Surg"},{"issue":"4 Suppl","key":"2022082610283278500_R28","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1016\/j.jviscsurg.2016.07.002","article-title":"Abbreviated laparotomy or damage control laparotomy: why, when and how to do it?","volume":"153","author":"Voiglio","year":"2016","journal-title":"J Visc Surg"},{"issue":"8","key":"2022082610283278500_R29","doi-asserted-by":"crossref","first-page":"1043","DOI":"10.1182\/blood-2016-01-636423","article-title":"Advances in the understanding of trauma-induced coagulopathy","volume":"128","author":"Chang","year":"2016","journal-title":"Blood"},{"issue":"1","key":"2022082610283278500_R30","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1007\/s12028-019-00882-6","article-title":"Ability of fibrin monomers to predict progressive hemorrhagic injury in patients with severe traumatic brain injury","volume":"33","author":"Esnault","year":"2020","journal-title":"Neurocrit Care"},{"issue":"2","key":"2022082610283278500_R31","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1093\/bja\/aeu233","article-title":"Damage control surgery in the era of damage control resuscitation","volume":"113","author":"Lamb","year":"2014","journal-title":"Br J Anaesth"},{"issue":"7","key":"2022082610283278500_R32","doi-asserted-by":"crossref","first-page":"655","DOI":"10.1016\/j.injury.2004.03.006","article-title":"Damage control neurosurgery","volume":"35","author":"Rosenfeld","year":"2004","journal-title":"Injury"},{"issue":"6","key":"2022082610283278500_R33","doi-asserted-by":"crossref","DOI":"10.3171\/2018.9.FOCUS18368","article-title":"Acute neurosurgical management of traumatic brain injury and spinal cord injury in French armed forces during deployment","volume":"45","author":"Dagain","year":"2018","journal-title":"Neurosurg Focus"},{"issue":"5","key":"2022082610283278500_R34","doi-asserted-by":"crossref","first-page":"895","DOI":"10.1007\/s00701-019-03880-x","article-title":"How I do it: supra-tentorial unilateral decompressive craniectomy","volume":"161","author":"Desse","year":"2019","journal-title":"Acta Neurochir"},{"issue":"4","key":"2022082610283278500_R35","doi-asserted-by":"crossref","first-page":"739","DOI":"10.1067\/msy.1998.91395","article-title":"Assessment of the relationship between timing of fixation of the fracture and secondary brain injury in patients with multiple trauma","volume":"124","author":"Kalb","year":"1998","journal-title":"Surgery"},{"issue":"4","key":"2022082610283278500_R36","doi-asserted-by":"crossref","first-page":"324","DOI":"10.1016\/S0002-9610(98)00208-6","article-title":"Timing of fracture fixation in blunt trauma patients with severe head injuries","volume":"176","author":"Velmahos","year":"1998","journal-title":"Am J Surg"},{"issue":"5","key":"2022082610283278500_R37","doi-asserted-by":"crossref","first-page":"E462","DOI":"10.1093\/neuros\/nyab003","article-title":"Letter: cranioplasty reverses dysfunction of the solutes distribution in the brain parenchyma after decompressive craniectomy","volume":"88","author":"Beucler","year":"2021","journal-title":"Neurosurgery"},{"key":"2022082610283278500_R38","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1016\/j.wneu.2017.02.097","article-title":"Management of war-related ballistic craniocerebral injuries in a French role 3 hospital during the Afghan campaign","volume":"102","author":"Dagain","year":"2017","journal-title":"World Neurosurg"},{"issue":"1","key":"2022082610283278500_R39","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1016\/j.injury.2015.09.022","article-title":"Hybrid treatment combining emergency surgery and intraoperative interventional radiology for severe trauma","volume":"47","author":"Kataoka","year":"2016","journal-title":"Injury"}],"container-title":["Military Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/milmed\/article-pdf\/187\/9-10\/1127\/45554854\/usab555.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/milmed\/article-pdf\/187\/9-10\/1127\/45554854\/usab555.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,8,26]],"date-time":"2022-08-26T10:30:18Z","timestamp":1661509818000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/milmed\/article\/187\/9-10\/1127\/6509891"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,1,17]]},"references-count":39,"journal-issue":{"issue":"9-10","published-online":{"date-parts":[[2022,1,17]]},"published-print":{"date-parts":[[2022,8,25]]}},"URL":"https:\/\/doi.org\/10.1093\/milmed\/usab555","relation":{},"ISSN":["0026-4075","1930-613X"],"issn-type":[{"value":"0026-4075","type":"print"},{"value":"1930-613X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2022,9,1]]},"published":{"date-parts":[[2022,1,17]]}}}