Study of factors related to early mortality after primary decompressive craniectomy in patients with severe traumatic brain injury

Abstract

Background: Traumatic brain injury is considered one of the leading causes of death in paediatrics and adults less than 45 years. Decompressive craniectomy is a common neurosurgical procedure aiming to relieve raised intracranial pressure. In present study we aimed to evaluate factors related to early mortality after primary decompressive craniectomy in patients with severe traumatic brain injury. Material and Methods: Present study was single-centre, prospective, observational study, conducted in patients age > 15 years, with severe traumatic brain injury in whom primary decompressive craniectomies (within 24 hours of trauma) were performed at our centre. Results: During study period total 42 patients satisfying study criteria underwent primary decompressive craniectomy at our centre. Most of patients were male (85.71 %), from age group 31-45 years (50 %), with severe (≤ 8) Glasgow Coma Scale scores on admission (54.76%), common etiology was road traffic accidents. Most of patients were operated within 6-12 hours from trauma (45.24%) and left side was common surgical site (57.14%). At discharge from ICU - Glasgow Outcome score (GOS) outcome was poor in 22 patients (52.38 %) and good outcome noted in 20 patients (47.62 %). Mortality at discharge was noted in 16 patients (38.10%). Conclusion: Advanced age, GCS ≥ 8, timing of surgery (>12 hours), presence of pupillary asymmetry on admission, presence of lung or abdominal injury, hypotension at admission (SBP < 90 mm hg), mean midline shift ( > 7 mm), mean volume of the bleed ( > 70 ml), bone flap ≥130 cm², intraventricular extension of the bleed present and surgery-related complication (hydrocephalus , extra-axial fluid collection, post-operative acute hematoma and skin flap ischemia) were predictors for early mortality patients with severe traumatic brain injury underwent primary decompressive craniectomy.