Decompressive craniectomy after traumatic brain injury: An observational study of 147 patients admitted in a Tunisian ICU

Abstract

ObjectiveTo analyze clinical, epidemiological, radiological characteristics and outcome of patients undergoing decompressive craniectomy (DC) after traumatic brain injury (TBI) and to identity predictive factors associated with poor prognosis. MethodsDemographic, clinical, and radiologic data from a retrospective study on unilateral or bilateral DC following TBI, admitted to the Intensive Care Unit (ICU) of a university hospital (Sfax-Tunisia), were collected during a 9-year period. ResultsWe included 147 patients. Ninety-nine patients (67.7%) were younger than 45 years. GCS ≤ 8 was found in 100 patients (68%). Primary DC was done for 104 patients (70.74%) and secondary DC was done for 43 patients (29.25%). Surgery was done within the first 6 h for 94 patients (63.9%). A mortality rate was at 42.2%. Independent factors associated with mortality were age > 65 years (p = 0.001;OR8.9;CI95% [1.90–42.02]),GCS ≤ 8 (p = 0.001;OR3.8;CI95%[1.69–8.54]),SOFA score > 5 (p = 0.01;OR2.2; CI95%[1.13–4.32]), persistence anisocoria or mydriasis after surgery (p < 0.001;OR13.16; CI95%[5.00–34.6]), hypercapnia > 45 mmHg (p = 0.002;OR4.2; CI95%[1.62–10.9]), disseminated intravascular coagulation (p = 0.003;OR4.3;CI 95% [1.57–11.96]) and use of corticosteroids (p = 0.034; OR2.04;CI95%[1.05–3.97]). Independent factors associated with poor outcome at discharge were GCS ≤ 8 (p = 0.029; OR 2.72; CI95% [1.09–6.78]), hydrocephalus (p = 0.017; OR4.13; CI95% [1.21–14.1]) and hyponatremia < 135 mmol/l (p = 0.009; OR6.77; CI95% [1.38–33.1]). Independent factors associated with poor outcome at 6 months were GCS ≤ 8 (p = 0.014; OR 3.93; CI 95% [1.27–12.1]), systolic arterial pressure < 90 mmHg at admission (p = 0.029; OR 3.54; CI 95% [2.48–5.05]) and diffuse axonal injury (p = 0.009; OR 3.89; CI 95% [1.35–11.2]). ConclusionDC can be life-saving for patients with TBI with decrease of mortality. The control of secondary systemic insults may lead to good prognosis.