Evidence map›Paper›PMID 27077906›Full record

Trial reportPloS one2016

No Routine Postoperative Head CT following Elective Craniotomy--A Paradigm Shift?

Ralph T Schär, Michael Fiechter, Werner J Z'Graggen, Nicole Söll, Vladimir Krejci, Roland Wiest, Andreas Raabe, Jürgen Beck

Registry-linked trialOpen access · goldAbstract readClinical Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in PloS one, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT01987648 (E-CRANIO Trial Study on Elective CRAniotomies), which is not on this map. Cited by 4 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed, 1 pooled it
2.0field-weighted citation impact, top 14% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT01987648 completednot on this map

E-CRANIO Trial Study on Elective CRAniotomies: Postoperative Neurointensive Care, Imaging and Outcome

TypeobservationalSponsorInsel Gruppe AG, University Hospital BernRan2011 to 2021Enrolled1,969ConditionsCraniotomy, Postoperative ComplicationsArmsElective Craniotomy Patients
3 · Its place in the literature

Who cites it

4 citing papers in PubMed, 1 synthesis or guideline pooled it, 24 citations in OpenAlex.

  1. Pooled it
  2. Review
  3. Observational
  4. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors at 2 institutions in 1 country.

Ralph T SchärDepartment of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Michael FiechterDepartment of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Werner J Z'GraggenDepartment of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Nicole SöllDepartment of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Vladimir KrejciDepartment of Anesthesiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Roland WiestDepartment of Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Andreas RaabeDepartment of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Jürgen BeckDepartment of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
University of Bern · CHUniversity Hospital of Bern · CH

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionPatient management following elective cranial surgery often includes routine postoperative computed tomography (CT). We analyzed whether a regime of early extubation and close neurological monitoring without routine CT is safe, and compared the rate of postoperative emergency neurosurgical intervention with published data.

methodsFour hundred ninety-two patients were prospectively analyzed; 360 had supra- and 132 had infratentorial lesions. Extubation within one hour after skin closure was aimed for in all cases. CT was performed within 48 hours only in cases of unexpected neurological findings.

resultsFour-hundred sixty-nine of the 492 patients (95.3%) were extubated within one hour, 20 (4.1%) within 3 hours, and three (0.6%) within 3 to 10 hours. Emergency CT within 48 hours was performed for 43/492 (8.7%) cases. Rate of recraniotomy within 48 hours for patients with postoperative hemorrhage was 0.8% (n = 4), and 0.8% (n = 4) required placement of an external ventricular drain (EVD). Of 469 patients extubated within one hour, 3 required recraniotomy and 2 required EVD placements. Of 23 patients with delayed extubation, 1 recraniotomy and 2 EVDs were required. Failure to extubate within one hour was associated with a significantly higher risk of surgical intervention within 48 hours (rate 13.0%, p = 0.004, odds ratio 13.9, 95% confidence interval [3.11-62.37]). DISCUSSION: Early extubation combined with close neurological monitoring is safe and omits the need for routine postoperative CT. Patients not extubated within one hour do need early CT, since they had a significantly increased risk of requiring emergency neurosurgical intervention.

trial registrationClinicalTrials.gov NCT01987648.

Indexed as

Tomography, X-Ray ComputedAdultAirway ExtubationCraniotomyElective Surgical ProceduresFemaleHeadHumansMaleMiddle AgedPostoperative PeriodSkull

Identifiers

PMID27077906
PMCPMC4831779
OpenAlexW2340903254

What OpenQuestion holds

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LicenceCC BY
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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.