Abstract
PurposeTo examine the prognostic discrimination and prediction of initial intracranial pressure (ICP) in patients with traumatic brain injury (TBI) undergoing decompressive craniectomy (DC).ResultsThe relationship between the initial ICP value and prognosis was quantified, and higher values indicated worse patient outcomes. Univariate analysis showed that the initial ICP value was significantly associated with mortality (odds ratio: 1.272, 95% confidence interval: 1.116-1.449; P<0.001) and unfavorable outcomes (odds ratio: 1.256, 95% confidence interval: 1.160-1.360; P<0.001). After adjustment for related outcome predictors of TBI in multivariate regression, the initial ICP value remained an independent predictor of unfavorable outcomes (odds ratio: 1.251, 95% confidence interval: 1.140-1.374; P=0.015) and mortality (odds ratio: 1.162, 95% confidence interval: 1.093-1.321; P=0.019).MethodsA retrospective study was conducted in 133 TBI patients after DC. Initial ICP was defined as the first ICP recorded during surgery. Mortality and Glasgow Outcome Scale score at the end of follow-up were used as outcome measures. Unfavorable and favorable outcomes were classified by a Glasgow Outcome Scale score of 1 to 3 and 4 to 5, respectively. We used binary logistic and proportional odds regression for prognostic analyses.ConclusionFor TBI patients undergoing DC, the initial ICP value provides great prognostic discrimination and is an independent predictor of unfavorable outcomes and mortality. We suggest that the initial ICP be included as a prognosticator in the overall assessment of prognosis of head-injured patients after DC.
Highlights
Traumatic brain injury (TBI) constitutes the major cause of death and severe disability among young people
We suggest that the initial intracranial pressure (ICP) be included as a prognosticator in the overall assessment of prognosis of head-injured patients after decompressive craniectomy (DC)
For head-injured patients undergoing DC that is usually combined with evacuation of traumatic mass lesions, the initial ICP provides great prognostic discrimination
Summary
Traumatic brain injury (TBI) constitutes the major cause of death and severe disability among young people. Intracranial lesions with intractable intracranial hypertension and malignant brain swelling in severe TBI patients continue to have devastating effects. A number of studies showed that decompressive craniectomy (DC) is an effective means of controlling high intracranial pressure (ICP), especially in patients with intraparenchymal lesions [1, 2]. DC is being more frequently performed; the prediction of postoperative outcomes is highly important in neurosurgical practice. Glasgow Coma Scale (GCS) score, the main tool for clinical assessment of TBI, is correlated with the outcomes after DC [3]. It is sometimes difficult to count the GCS score because head injured patients are frequently drunk, sedated, or intubated
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