Analysis of Long-Term Prognosis and Prognostic Predictors in Severe Brain Injury Patients Undergoing Decompressive Craniectomy and Standard Care

Abstract

Decompressive craniectomy (DC) is widely used to treat acute subdural haematoma and hemispheric swelling following traumatic brain injury (TBI). The therapeutic effect of DC on severe TBI treatment is still controversial. The aim of our study was to evaluate effectiveness of DC treatment and seek some prognostic predictors. According to the therapy method, we divided the patients into 2 groups: DC group and standard care group. Between 2010 and 2014, a total number of 223 severe TBI patients, containing 112 patients undergoing DC and 111 patients undergoing standard care, were enrolled into the study according to Glasgow Coma Scale (GCS). The long-term prognosis was evaluated by Extended Glasgow Outcome Scale 12 months after discharging from hospital. We used univariate analysis and receiver operating characteristic curves to explore prognostic predictors. The results showed that patients in the DC group had a lower mortality, but there was no statistical significance in long-term prognosis between these 2 groups. It seemed that admission GCS, platelet, neutrophile granulocyte, total protein, and albumin were associated with long-term prognosis in DC group and reactivity of pupils in standard care group. Simultaneously, using the multivariable logistic regression model, we confirmed that admission GCS and albumin were independent prognostic predictors for patients undergoing DC, and reactivity of pupils for those undergoing standard care. Our data suggested that DC was an effective therapy for severe TBI patients in reducing mortality, but it failed to improve long-term prognosis. Through our study, we could comprehend the characteristics of the 2 treatments and provide more scientific individuation therapy for severe TBI patients.

A Systematic Review and Meta-Analysis of the Effectiveness of Surgical Decompression in Treating Patients with Malignant Middle Cerebral Artery Infarction

“…31,32 The contrasting result could be due to the small number of studies in the present analysis that included older patients and the corresponding definition of t others as >70 years, resulting in exclusion of patients between 60 and 70 years of age. 33 The DESTINY II trial provides the strongest evidence so far for DC in older patients. Although case fatality was comparable with younger patients, functional outcome was worse in the older patients compared to the younger group in previous trials (19% versus 4%).…”

Risk Stratification in Patients with Severe Traumatic Acute Subdural Hematoma

“…Our RPA model provides two nodes separated by the status of the basal cistern in patients with a GCS of 6 to 8. Studies have shown that the presence or absence of basal cistern obliteration on the CT scan image is strongly associated with the prognosis of the patient 14,16,24) . Toutant et al 21) reported that a 77% mortality rate was observed when basal cistern obliteration existed.…”

Dipeptidyl Peptidase-4 deficiency effectively protects the brain and neurological function in rodent after acute Hemorrhagic Stroke

“…The HS accounts for nearby 30% of all types of acute stroke and usually has poorer prognostic Ivyspring International Publisher outcomes as compared to those of IS. Additionally, acute HS (i.e., AHS) patients who required surgical intervention will frequently develop permanent disability [5][6][7][8][9][10][11]. Furthermore, there is no data as to whether the pharmacomodulation is beneficial in patients who suffer from AHS and survive with permanent disability.…”