Decompressive Craniectomy in 14 Children With Severe Head Injury: Clinical Results With Long-Term Follow-Up and Review of the Literature

Suárez, Esther Pérez; González, Alberto Sánchez; Díaz, Carlos Pérez; García-Salido, Alberto; Garde, Amelia Martínez de Azagra; Flores, Juan

doi:10.1097/ta.0b013e318211071f

Cited by 27 publications

(21 citation statements)

References 19 publications

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“…10 In a study of 14 children with severe TBI, Pérez Suárez et al also reported a favorable outcome, with a mean GOS score of 4.4 (range 4-5) at the 2-year follow-up. 17 In our study the majority of our patients who were treated with DC had a favorable GOS score.…”

Section: % (5/17supporting

confidence: 47%

Outcome of children with severe traumatic brain injury who are treated with decompressive craniectomy

Mhanna

Mallah

Verrees³

et al. 2015

PED

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OBJECT Decompressive craniectomy (DC) for the management of severe traumatic brain injury (TBI) is controversial. The authors sought to determine if DC improves the outcome of children with severe TBI. METHODS In a retrospective, case-control study, medical records of all patients admitted to the pediatric ICU between May 1998 and May 2008 with severe TBI and treated with DC were identified and matched to patients who were treated medically without DC. Medical records were reviewed for patients’ demographic data and baseline characteristics. RESULTS During the study period, 17 patients with severe TBI treated with DC at a median of 2 hours (interquartile range [IQR] 1–14 hours) after admission were identified and matched to 17 contemporary controls. On admission, there were no differences between DC and control patients regarding age (10.2 ± 5.9 years vs 12.4 ± 5.4 years, respectively [mean ± SD]), sex, weight, Glasgow Coma Scale score (median 5 [IQR 3–7] vs 4 [IQR 3–6], respectively; p = 0.14), or the highest intracranial pressure (median 42 [IQR 22–54] vs 30 [IQR 21–36], respectively; p = 0.77). However, CT findings were significant for a higher rate of herniation and cerebral edema among patients with DC versus controls (7/17 vs 2/17, respectively, had herniation [p = 0.05] and 14/17 vs 6/17, respectively, had cerebral edema [p = 0.006]). Overall there were no significant differences in survival between patients with DC and controls (71% [12/17] vs 82% [14/17], respectively; p = 0.34). However, among survivors, at 4 years (IQR 1–6 years) after the TBI, 42% (5/12) of the DC patients had mild disability or a Glasgow Outcome Scale score of 5 vs none (0/14) of the controls (p = 0.012). CONCLUSIONS In this retrospective, small case-control study, the authors have shown that early DC in pediatric patients with severe TBI improves outcome in survivors. Future prospective randomized controlled studies are needed to confirm these findings.

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Section: % (5/17supporting

confidence: 47%

Outcome of children with severe traumatic brain injury who are treated with decompressive craniectomy

Mhanna

Mallah

Verrees³

et al. 2015

PED

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“…When the brain edema is resolved as indicated by computerized tomography, the harvested bone segment is surgically replaced at about 6 to 12 weeks, based on the neurosurgeon's assessment. If the autologous bone flap is unable to be used, alternative implant materials such as titanium may be used (Beauchamp et al, 2010; Suarez et al, 2011) Bone flap replacement is preferred as soon as deemed possible by the neurosurgical and rehabilitative team. The wearing of protective head gear until replacement is based on physician preference and patient safety needs.…”

Section: Acute and Rehabilitative Management Goals For Tbimentioning

confidence: 99%

Moderate-to-Severe Traumatic Brain Injury in Children: Complications and Rehabilitation Strategies

Popernack¹,

Gray²,

Reuter‐Rice³

2015

Journal of Pediatric Health Care

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Traumatic brain injury (TBI) is the leading cause of death in children in the United States. Each year 37,200 children sustain a severe TBI, with up to 1.3 million life-years potentially adversely affected. Severe pediatric TBI is associated with significant mortality and morbidity. Of the children who survive their injury, more than 50% experience unfavorable outcomes 6 months after the injury. Although TBI-associated death rates decreased between 1997–2007, disabilities for TBI survivors continue to have both a direct and indirect impact on the economic and human integrity of our society. The degree of disability varies with the severity and mechanism of the injury, but a realm of physical and emotional deficits may be evident for years after the injury occurs. This article describes the pathophysiology of moderate to severe TBI, its associated complications, and opportunities to improve patient outcomes through use of acute management and rehabilitation strategies. To address the many challenges for TBI survivors and their families, including significant financial and emotional burdens, a collaborative effort is necessary to help affected children transition seamlessly from acute care through long-term rehabilitation.

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“…Moreover, many refractory cases of intracranial hypertension necessitate individual decision-making and use of second tier modalities for many patients [5]. Recently, decompressive craniectomy in young age groups has garnered much interest and has shown favorable outcomes for management of intracranial hypertension [6][7][8]. Decompressive craniectomy in this age group has been associated with a high rate of complications such as flap necrosis, empyema, and CSF leak from wound site [1,3].…”

Section: Discussionmentioning

confidence: 99%

Decompressive craniectomy for infants: a case series of five patients

et al. 2015

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Decompressive Craniectomy in 14 Children With Severe Head Injury: Clinical Results With Long-Term Follow-Up and Review of the Literature

Cited by 27 publications

References 19 publications

Outcome of children with severe traumatic brain injury who are treated with decompressive craniectomy

Outcome of children with severe traumatic brain injury who are treated with decompressive craniectomy

Moderate-to-Severe Traumatic Brain Injury in Children: Complications and Rehabilitation Strategies

Decompressive craniectomy for infants: a case series of five patients

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