Abstract
Decompressive craniectomy (DC) is a management option to control raised Intracranial pressure (ICP) in Traumatic Brain Injury (TBI) with inconsistent evidence for its outcomes and their determinants. The aim of this study was to assess the outcomes and determinants of outcomes of DC done in National Hospital of Sri Lanka (NHSL) at one year and three years of follow-up. Patients who underwent DC for TBI within 6 months period from 01/02/2016 to 31/07/2016 at Neurotrauma Centre, NHSL were included in the study. Data were retrieved from medical records. Outcomes were evaluated by interviewing patients/relatives over the telephone using standard questionnaire for extended Glasgow Outcome scale (GOS-E). Inclusion and exclusion criteria matched 118 patients were selected and 89 (75.42%) contactable patients were included in the analysis. Majority (86.4%) were males and median age was 45 years. There were 56 primary DCs and 33 secondary DCs. Favorable outcomes (GOS-E 5-8) were seen in 20.2% and in 24.7% at the end of one year and three years respectively. Younger age, good pupillary reaction and higher GCS on admission were associated with statistically significant favorable outcomes (P<0.05). Pupillary symmetry, timing of DC (primary or secondary), time elapsed from time of injury to performing primary DC, type of DC, whether CT shows an isolated lesion or multiple lesions, submission to tracheostomy, having medical comorbidities and post-operative infections were not predictive of the outcome. Favorable functional outcomes following DC for TBI is limited to 20-25%. Younger age, good pupillary reaction and higher GCS are predictors of favorable functional outcomes.
Highlights
Traumatic brain injury (TBI) remains as one of the commonest cause of death in trauma [1 - 3]
Favorable functional outcomes following Decompressive craniectomy (DC) for traumatic brain injury (TBI) is limited to 20-25%
Cause of injury, pre-intubation Glasgow Coma Scale (GCS), pupillary symmetry and reaction at admission, comorbidities, computerized tomography (CT) findings; extradural haemorrhage (EDH), subdural haemorrhage (SDH), subarachnoid haemorrhage (SAH), cerebral contusion, type of DC, timing of DC, time elapsed from time of injury to performing primary DC, duration of ICU/hospital stay, submission to tracheostomy, data on post-operative infections and other complications were collected
Summary
Traumatic brain injury (TBI) remains as one of the commonest cause of death in trauma [1 - 3]. Strategies of minimizing secondary brain injury have contributed to the improvement of mortality following TBI. The best proof for this is the reduction of mortality following severe TBI over last three decades from 50% to 25% [4]. Apart from barbiturate coma, decompressive craniectomy (DC) remains as an ultimate option in management of intractable intracranial hypertension in TBI. There is a significant discrepancy in available literature regarding outcomes and their determinants of this procedure and yet no study has been published on this topic in the local context. Decompressive craniectomy (DC) is a management option to control raised intracranial pressure (ICP) in traumatic brain injury (TBI) with inconsistent evidence for its outcomes and their determinants
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