739: DECOMPRESSIVE CRANIECTOMY IN CHILDREN WITH TRAUMATIC BRAIN INJURY IN THE U.S. FROM 2000 TO 2019

Abstract

Introduction: The role of decompressive craniectomy (DC) in children with TBI and intracranial hemorrhage (ICH) or refractory raised intracranial pressure (ICP) is undetermined. This study aimed to describe the prevalence of DC and outcomes associated with DC and ICH in children with TBI. Methods: A retrospective analysis of Kids’ Inpatient Database from 2000 to 2019 was performed. Hospitalized children from 28 days to 20 years were selected. ICD 9 and ICD 10 codes were used to identify diagnosis and procedure variables. Data were compared between early DC (procedure day = 0) and late DC (procedure day >0) using chi-square and Mann-Whitney U tests. Multivariable analysis was performed to determine the adjusted odds of mortality after early vs late DC and various types of ICH and raised ICP. Linear trends in the prevalence of DC were analyzed using the Extended Mantel-Haenszel test. Results: Among 23,804,204 hospitalized children, 193,456 children had TBI (8.1 per 1000 discharges). There was a decreasing trend in TBI hospitalization (p< 0.001) and associated mortality (p < 0.001). DC was documented in 9,887 (5.1%). DC procedure day was documented in 8,480 with early DC in 67.1% and late DC in 32.9%. In patients with TBI and DC, epidural hemorrhage (EH) was present in 19.6%, subdural hemorrhage (SH) in 11.4%, subarachnoid hemorrhage (SAH) in 5.1%, multiple hemorrhage in 51.8%, any hemorrhage in 83.5%, and raised ICP (presence of cerebral edema or EVD) in 6.6%. Early DC was more common in children with EH (OR=1.5; 95%CI:1.4-1.7) and late DC was common in SH (OR=0.7; 95%CI:0.6-0.8), SAH (OR=0.6; 95%CI:0.5-0.7) and raised ICP (OR=0.54; 95%CI:0.48-0.61). The overall mortality and morbidity associated with TBI children with DC was 36.6% and was higher with late DC (OR:1.59; 95%CI: 1.45-1.74). On multivariable regression analysis, morbidity-mortality rate was higher in raised ICP (aOR=6.5; 95%CI:5.5-7.6), SAH (aOR=3.0; 95%CI: 3.3-3.8), SH (aOR=1.9; 95%CI:1.6-2.2), and lower with early DC (aOR= 0.8; 95%CI:0.7-0.9), and EH (aOR=0.27; 95%CI:0.22-0.31). Conclusions: In our national study, in children with TBI, 5% underwent DC. ICH was present in over 80% of children who had DC. The morbidity-mortality was lower with early DC and EH, and higher with raised ICP, SAH, SH and late DC.