Decompressive craniectomy for severe traumatic brain injury in children: analysis of long-term neuropsychological impairment and review of the literature

Ballestero, Matheus Fernando Manzolli; Furlanetti, Luciano; Augusto, Lucas Pires; Chaves, Pedro Henrique Carmona; Santos, Marcelo Volpon; Oliveira, Ricardo Santos de

doi:10.1007/s00381-019-04274-1

Cited by 19 publications

(15 citation statements)

References 25 publications

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“…The age distribution in our study concurs with the typically described incidence peaks during infancy and adolescence for the occurrence of and mortality from TBI [1]: Additionally, the initial GCS values are in line with findings from other reports on children undergoing DC for severe TBI [22,23]. Mortality was lower than predicted in children above six years of age undergoing decompressive craniectomy.…”

Section: Discussionsupporting

confidence: 91%

“…Several studies reported favorable outcomes several months or years after DC, with percentages varying between 50 and 100% [4,7,20,23,24]. In contrast, one study found that 38% of patients undergoing DC died and cognitive abnormalities were present in more than 50% of survivors [22]. The only paediatric RCT on this topic reported better outcomes after DC within 6 hours of ICP rise compared to medical management (54 vs.…”

Section: Discussionmentioning

confidence: 99%

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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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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

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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“…The authors found no correlation between the time from the primary insult to DC and the recovery status as measured with GOSE or the patient's ability to return to school, thus highlighting the importance of clinical judgement before DC, as refractorily high ICP develops with varying delay from the primary injury. The mean time of 1.6 days from the insult to DC in the present study corresponds to those published earlier [3,22,23].…”

Section: Clinical Outcome After Decompressive Craniectomysupporting

confidence: 91%

“…Of note, the present cohort mainly comprised adolescent patients, which may influence the observed rate of favourable outcome as younger age is traditionally taken as a predictor of poor outcome after paediatric TBI [19][20][21]. In the setting of DC, however, the effect of age is more unclear, as contradicting associations between age and mortality or recovery have been reported [3,4,22,23].…”

Section: Clinical Outcome After Decompressive Craniectomymentioning

confidence: 99%

Favourable long-term recovery after decompressive craniectomy: the Northern Finland experience with a predominantly adolescent patient cohort

et al. 2022

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Purpose Decompressive craniectomy (DC) is an effective treatment of intracranial hypertension. Correspondingly, the procedure is increasingly utilised worldwide. The number of patients rendered vegetative following surgery has been a concern—a matter especially important in children, due to long anticipated lifetime. Here, we report the long-term outcomes of all paediatric DC patients from an 11-year period in a tertiary-level centre that geographically serves half of Finland. Methods We identified all patients younger than 18 years who underwent DC in the Oulu University Hospital between the years 2009 and 2019. Outcomes and clinicoradiological variables were extracted from the patient records. Results Mean yearly prevalence of brain injury requiring DC was 1.34/100 000 children—twenty-four patients underwent DC during the study period and 21 (88%) survived. The median age of the patients was 16.0 years, and the median preoperative GCS was 5.0 (IQR 5.0). Fifteen patients (63%) had made a good recovery (Extended Glasgow Outcome Scale ≥ 7). Of the surviving patients, two (9.5%) had not returned to school. After traumatic brain injury (n = 20), the Rotterdam CT score (mean 3.0, range 1 to 5) was not associated with mortality, poor recovery or inability to continue school (p = 0.13, p = 0.41, p = 0.43, respectively). Absent basal cisterns were associated with mortality (p = 0.005), but not with poor recovery if the patient survived DC (p = 0.81). Hydrocephalus was associated with poor recovery and inability to continue school (p = 0.01 and p = 0.03, respectively). Conclusion Most of our patients made a favourable recovery and were able to continue school. No late mortality was observed. Thus, even in clinically and radiologically severely brain-injured children, decompressive craniectomy appears to yield favourable outcomes.

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“… 1 , 22 The initial GCS values are in line with findings from other reports on children undergoing DC for severe TBI. 23 , 24 Age younger than 6 years was an independent risk factor for poor outcomes and death in the logistic regression. Manfiotto and colleagues reported that of 150 children undergoing DC, those with poor outcome were significantly younger at the time of the accident.…”

Section: Discussionmentioning

confidence: 88%

Functional Short-Term Outcomes and Mortality in Children with Severe Traumatic Brain Injury: Comparing Decompressive Craniectomy and Medical Management

Bruns

Kamp

Lange

et al. 2022

Journal of Neurotrauma

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The effect of decompressive craniectomy (DC) on functional outcomes and mortality in children after severe head trauma is strongly debated. The lack of high-quality evidence poses a serious challenge to neurosurgeons' and pediatric intensive care physicians' decision making in critically ill children after head trauma. This study was conducted to compare DC and medical management in severely head-injured children with respect to short-term outcomes and mortality. Data on patients <18 years of age treated in Germany, Austria, and Switzerland during a 10-year period were extracted from TraumaRegister DGU ® , forming a retrospective multi-center cohort study. Descriptive and multi-variable analyses were performed to compare outcomes and mortality after DC and medical management. Of 2507 patients, 402 (16.0%) received DC. Mortality was 20.6% after DC and 13.7% after medical management. Poor outcome (death or vegetative state) occurred in 27.6% after DC and in 16.1% after medical management. After risk adjustment by logistic regression modeling, the odds ratio was 1.56 (95% confidence interval 1.01-2.40) for poor outcome at intensive care unit discharge and 1.20 (0.74-1.95) for mortality after DC. In summary, DC was associated with increased odds for poor short-term outcomes in children with severe head trauma. This finding should temper enthusiasm for DC in children until a large randomized controlled trial has answered more precisely if DC in children is beneficial or increases rates of vegetative state.

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Decompressive craniectomy for severe traumatic brain injury in children: analysis of long-term neuropsychological impairment and review of the literature

Cited by 19 publications

References 25 publications

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

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

Favourable long-term recovery after decompressive craniectomy: the Northern Finland experience with a predominantly adolescent patient cohort

Functional Short-Term Outcomes and Mortality in Children with Severe Traumatic Brain Injury: Comparing Decompressive Craniectomy and Medical Management

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