Decompressive craniectomy in diffuse traumatic brain injury: An industrial hospital study

Abstract

Context:High intracranial pressure is the most frequent cause of mortality and disability after severe traumatic brain injury (TBI) which is treated by first-line therapeutic measures. When these measures fail, second-line therapies are started. Among second-line therapies, decompressive craniectomy (DC) has been used. It improves the functional outcome in these patients.Aim:This study aims to analyze the clinicoradiological factors associated with the prognosis of severe TBI in patients undergoing DC.Settings and Design:It was a retrospective case series study from April 2014 to March 2016.Subjects and Methods:A total of 85 patients (admitted at Tata Main Hospital, Jamshedpur) with severe diffuse TBI with clinical and radiological evidence of intracranial hypertension who were refractory to first-tier therapies and required DC were included in our study. Cases excluded were patients with age <10 years and polytrauma patients.Results:Out of 85 cases, 55 were males, and thirty were females (male:female = 1.8:1) with the age ranging from 17 to 68 years. Road traffic accident was the leading cause of injury in 69.5% cases. A total of 49 (58%) patients were of Glasgow coma scale (GCS) 4–6 whereas 36 (42%) patients had GCS 7–8. Computed tomography (CT) scan brain was classified as per Marshall CT classification. Bifrontotemporal DC was done in 29% cases, and unilateral frontotemporoparietal craniectomy was done in 71%.Conclusions:Patients with younger age, early surgical intervention, better preoperative GCS score, and with low Marshall CT score have better prognosis.

Outcome of decompressive craniectomy for traumatic brain injury: An institutional-based analysis from Nepal

“…Choudhary and Bhargava from Indian reported that younger patients had more favorable outcome (64% vs. 19%) than patients of age >50 years, and also, mortality was higher among the elderly (above 50 years). [12] Similar to the above findings, other previous studies have also reported age as one of the predictors of better outcome, age being more than 50 years associated with unfavorable outcome and higher complications. [13][14][15][16] We observed that patients with GCS score of 8 and above had significantly higher favorable outcome (72.2%, P < 0.001)) as well as higher survival rate (83.3%, P = 0.039).…”

Prognostic Factors for Decompressive Hemicraniectomy in Severe Traumatic Brain Injury Patients with Traumatic Mass Lesions: A Prospective Experience from a Developing Country

“…14 The clinical outcome of DC in sTBI is, however, varied from 7% to 70%. [15][16][17][18][19][20][21][22][23][24][25][26] This controversy in the literature is partly due to variations in care, selection criteria, type of craniectomy performed (where a large DHC is most effective than other types. 27 Still, importantly, the disparity between studies is also due to variation in parameters of their patient population.…”

Inter‐hospital variation in surgical intensity for trauma admissions: A multicentre cohort study

“…Indeed, amongst others, WSES and EAST emit multiple recommendations on the non‐operative management of thoracoabdominal injuries 6,7 . The decrease observed in surgical intensity for neurotrauma during the study period may be explained by lower propensity to perform decompressive craniotomies due to controversial results from recent randomised controlled trials 10,44‐47 and recommendations emitted by the Brain Injury Foundation and Choosing Wisely 10,48 …”