Abstract
ObjectivesTraumatic brain injury (TBI) is a worldwide major health problem associated with a high rate of morbidity and mortality. Intracranial hypertension following TBI is the main but not the only cause of early mortality. Decompressive craniectomy (DC) is used to decrease the intracranial pressure (ICP) and prevent brain herniation following TBI; however, the clinical outcome after DC for patients with TBI generates continuous debate. Prediction of early mortality after DC will help in making the surgery decision.The aim of this study is to predict early mortality after DC based on the initial clinical and radiological findings.MethodsIn this study, 104 patients with severe traumatic brain injury have been treated by decompressive craniectomy and were retrospectively analyzed. Patients were divided into two groups; group I involved 32 patients who died within 28 days while group II involved 72 patients who survived after 28 days. The relationship between initial Glasgow Coma Scale score (GCS), pupil size and reactivity, associated injuries, and radiological findings were analyzed as predictor factors for early mortality.ResultsA total of 104 patients with severe TBI have been treated by DC and were analyzed; the early mortality occurred in 32 patients, 30.77%. There is a significant difference between groups in gender, mean GCS, Marshall scale, presence of isochoric pupils, and lung injury.After stratification, odds of early mortality increases with the lower GCS, higher Marshall scale, lung injury, and abdominal injury while male gender and the presence of isochoric pupils decrease the odds of mortality. After univariate regression, the significant impact of GCS disappears except for GCS-8 which decreases the odds of mortality in comparison to other GCS scores while higher Marshall scale, presence of isochoric pupils, and lung injury increase the odds of mortality, but most of these effects disappear after multiple regressions except for lung injury and isochoric pupils.ConclusionPrediction of early mortality after DC is multifactorial, but the odds of early mortality after decompressive craniectomy in severe traumatic brain injury are progressively increased with the lower GCS, higher Marshall scale, and the presence of lung or abdominal injury.
Highlights
Traumatic brain injury (TBI) is a worldwide major and challenging public health problem [1,2,3,4] with 39% global mortality [5].TBI is considered one of the leading causes of death in pediatrics and adults less than 45 years [2]
A total of 104 patients with severe TBI have been treated by Decompressive craniectomy (DC) and were analyzed; the early mortality occurred in 32 patients, 30.77%
The significant impact of Glasgow Coma Scale (GCS) disappears except for GCS-8 which decreases the odds of mortality in comparison to other GCS scores while higher Marshall scale, presence of isochoric pupils, and lung injury increase the odds of mortality, but most of these effects disappear after multiple regressions except for lung injury and isochoric pupils
Summary
Traumatic brain injury (TBI) is a worldwide major and challenging public health problem [1,2,3,4] with 39% global mortality [5].TBI is considered one of the leading causes of death in pediatrics and adults less than 45 years [2]. Prediction of the mortality and functional outcome after severe traumatic brain injury TBI is an important but complicated subject. It was found that post-traumatic intracranial hypertension increases the risk of mortality but is considered the main cause of preventable death after traumatic brain injury [3, 6, 7]. Decompressive craniectomy (DC) had been described during the early years of the twentieth century for the treatment of intracranial hypertension and to prevent brain herniation [5, 8], becoming widely used as potentially life-saving procedures in cases with severe traumatic brain injury [2, 8,9,10]; there is still uncertainty regarding the effectiveness of DC on the outcome after TBI [11]. The ICP returns to normal level within 4 weeks after trauma [13], and according to this finding, decompressive craniectomy which decreases the ICP will modify the pathogenesis and can decrease the mortality during the initial 4 weeks of trauma
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