Emergency Room Admissions of Patients with Glioblastoma

Introduction: Patients with glioblastoma (GBM) often are sent to an emergency room (ER) after initial imaging studies reveal a brain tumor, which may lead to decreased choices for management. We sought to determine the rates of patients with GBM admitted through the ED at the time of initial diagnosis.

Methods: Records of all patients at our institution with pathology confirmed diagnosis of glioblastoma or high-grade astrocytoma from 2014-2022 were queried for analysis. Patients were excluded if surgery was performed for recurrence or age was less than 18 years old. The total analytical sample included 419 patients.

Results: The total sample included 419 patients, of whom 359 (85.7%) were admitted through the ER. Fifty-six (15.6%) of these patients were diagnosed with outpatient imaging before arrival and 124 (34.5%) were transferred from another hospital. Of the patients who arrived through the ER, 269 (74.9%) had resection of the tumor during their initial operation versus 89 (24.8%) who only had a biopsy of the tumor. In total, patients with biopsy had a higher median age (71 years, p = 0.001). There was no significance in operation type and admission route (p=0.775). The median time from ED to OR was 5 days (IQR 3-7). Nine patients were enrolled in surgical trials, with the majority of trials in this period being clinical rather than surgical, all of whom were admitted through the ER. Insurance did not have statistical significance in admission route (ER versus planned surgery) (p=0.07) with the majority of patients having Medicare (N=196, 46.8%).

Conclusion : As preoperative entry into surgical trials becomes increasingly important for improving the treatment of persons with glioblastomas, neurosurgeons can educate their colleagues and the lay community about the need to avoid automatic ER referrals after imaging diagnosis of a brain tumor.