Long-Term Quality of Life after Decompressive Craniectomy in Severe Traumatic Brain Injury and Stroke

Vicino A,Benaim C,Léger B,Vuadens P

doi:10.26420/physmedrehabilint.2021.1186

Abstract

Purpose: Decompressive Craniectomy (DC) can rapidly reduce intracranial pressure and save lives in the acute phase of severe Traumatic Brain Injury (TBI) or stroke, but little is known about the long-term outcome after DC. We evaluated Quality of Life (QoL) a few years after DC for severe TBI/stroke. Methods: The following data were collected for stroke/TBI patients hospitalized for neurorehabilitation after DC: 1) at discharge, motor and cognitive sub-scores of the Functional Independence Measure (motor-FIM (score 13-91) and cognitive-FIM (score 5-35)) and 2) more than 4 years after discharge, the QOLIBRI health-related QoL (HR-QoL) score (0-100; <60 representing low or impaired QoL) and the return to work (RTW: 0%, partial, 100%). Results: We included 88 patients (66 males, median age 38 (interquartile range 26.3-51.0), 65 with TBI/23 stroke); 46 responded to the HR-QoL questionnaire. Responders and non-responders had similar characteristics (age, sex, functional levels upon discharge). Median motor-FIM and cognitive- FIM scores were 85/91 and 27/35, with no significant difference between TBI and stroke patients. Long-term QoL was borderline low for TBI patients and within normal values for stroke patients (score 58.0 (42.0-69.0) vs. 67.0 (54.0- 81.5), p=0.052). RTW was comparable between the groups (62% full time). Conclusion: We already knew that DC can save the lives of TBI or stroke patients in the acute phase and this study suggests that their long-term quality of life is generally quite acceptable.

Highlights

Background and PurposeStroke and Traumatic Brain Injury (TBI) are among the leading causes of death and disability in developed countries
We already knew that Decompressive Craniectomy (DC) can save the lives of TBI or stroke patients in the acute phase and this study suggests that their long-term quality of life is generally quite acceptable
From the 95 consecutive patients hospitalized at the Clinic during the inclusion period after a DC, 88 met the inclusion criteria, but only 46 (52%) completed the health-related quality of life (QoL) (HR-QoL) questionnaire and 45 (51%) had data on Return to Work (RTW), despite the reminders

Summary

Introduction

Background and PurposeStroke and Traumatic Brain Injury (TBI) are among the leading causes of death and disability in developed countries. In Switzerland, they have an incidence of approximately 240/100,000 and 170/100,000 (8.2/100,000 considered severe) [1,2,3], and represent two of the leading causes of death, with mortality at 14.4% for stroke and 20% to 30% for TBI in the first year and 50% and 35% in the following 5 years. These two conditions induce major chronic disability in the population, with a significant impact on quality of life (QoL) [4,5].

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Conclusion