Predictors of poor outcome of decompressive craniectomy in pediatric patients with severe traumatic brain injury: a retrospective single center study from Pakistan

Khan, Saad Akhtar; Shallwani, Hussain; Shamim, Muhammad Shahzad; Murtaza, Ghulam; Enam, Syed Ather; Qureshi, Reema Obaid; Tahir, Muhammad Zubair

doi:10.1007/s00381-013-2225-2

Cited by 19 publications

(9 citation statements)

References 21 publications

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“…[25] Ucar et al, [12] found the initial GCS and age as predictors of outcome in a series of 100 DC performed in the severe head injury group. Among the pediatric population, Khan et al, [26] published a retrospective study of 25 patients of age range 1-5 years with TBI who underwent a DC. Univariate analysis revealed that the GCS ≤5, a delay in presentation >150 min, a DC performed >4 h post injury, and an intraoperative blood loss >300 ml were significant predictors of a poor outcome.…”

Section: Discussionmentioning

confidence: 99%

Decompressive craniectomy in traumatic brain injury: A single-center, multivariate analysis of 1,236 patients at a tertiary care hospital in India

et al. 2015

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The severity of head injury, performing a duraplasty rather than a slit durotomy, avoidance of a contralateral DC, and the presence of preoperative hypotension, infarct, and/or pupillary asymmetry have the highest odds of predicting the short term GOS at the time of discharge, after a DC in patients with TBI. Although DC carries a high risk of mortality, the probability of the survivors having a favorable outcome is significantly more as compared to those who remain in a PVS.

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Section: Discussionmentioning

confidence: 99%

Decompressive craniectomy in traumatic brain injury: A single-center, multivariate analysis of 1,236 patients at a tertiary care hospital in India

et al. 2015

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“…In children, only one RCT including only 27 patients is available on DC [6], along with numerous small studies, case series, and one larger retrospective study including 150 children with DC [4][5][6][7][8][9][10][11][15][16][17][18][19]. Studies on functional outcome reported better outcomes in children after DC compared to conservative treatment [4,6,20] or no difference [5].…”

Section: Introductionmentioning

confidence: 99%

Mortality and outcomes after decompressive craniectomy in children with severe traumatic brain injury

Bruns

Kamp

Lange

et al. 2021

Preprint

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PurposeThe effect of decompressive craniectomy (DC) on mortality and outcomes in children with elevated intracranial pressure after severe head trauma is strongly debated and high-quality evidence is lacking. This study was conducted to determine whether DC in children with severe head trauma is associated with a decrease in mortality or poor outcomes at discharge from the intensive care unit.MethodsData on patients < 18 years of age treated in Germany, Austria, and Switzerland during a ten-year period were extracted from TraumaRegister DGU®, forming a retrospective multi-centre cohort study. Descriptive and multivariable analyses were performed to compare mortality and outcomes after decompressive craniectomy and medical management.Results2507 patients were included, of which 402 underwent decompressive craniectomy. Mortality was 20.6 % in children undergoing DC compared to 13.7 % after medical management. Observed and predicted mortality after DC and medical management matched in all subgroups except in children between six and 17 years of age, where mortality after DC was lower than predicted. Poor outcome was observed in 27.6 % of DC patients vs. 16.1 % receiving medical management. Logistic regression revealed slightly negative effects of DC on mortality (odds ratio 1.20, not significant) and outcomes (odds ratio 1.56 (95% confidence interval 1.01-2.40).ConclusionDC did not decrease overall mortality or rates of poor outcome. However, children above six years of age may benefit from DC. High quality prospective studies are urgently needed.

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“…Overall mortality rate was 25% and a good outcome was achieved in 80% of survivors. Recent studies have documented good outcomes in paediatric patients after DC [30,31]. Kan et al [12] studied 51 children with severe TBI with a mean age of 6.6 years wherein a secondary DC was considered only in cases with sustained ICP425 mm Hg unresponding to a trial of maximal medical therapy.…”

Section: Discussionmentioning

confidence: 99%

Surgical results of decompressive craniectomy in very young children: A level one trauma centre experience from India

et al. 2015

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Decompressive craniectomy offers a survival advantage in almost 50% of young children with severe TBI and should be used judiciously. The highest mortality was within the 1st week of surgery. The cut-off limit of 20 mm Hg for surgical decompression might not be applicable to young children and a low threshold ICP needs to be considered. Factors associated with increased mortality are high opening ICP (>20 mm Hg), GCS <8, diffuse cerebral oedema and infant age group. Timing of DC remains crucial. Further prospective studies are necessary to optimize the timing and ICP limit for surgical decompression.

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Predictors of poor outcome of decompressive craniectomy in pediatric patients with severe traumatic brain injury: a retrospective single center study from Pakistan

Cited by 19 publications

References 21 publications

Decompressive craniectomy in traumatic brain injury: A single-center, multivariate analysis of 1,236 patients at a tertiary care hospital in India

Decompressive craniectomy in traumatic brain injury: A single-center, multivariate analysis of 1,236 patients at a tertiary care hospital in India

Mortality and outcomes after decompressive craniectomy in children with severe traumatic brain injury

Surgical results of decompressive craniectomy in very young children: A level one trauma centre experience from India

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