Early Pressure Dressing for the Prevention of Subdural Effusion Secondary to Decompressive Craniectomy in Patients With Severe Traumatic Brain Injury

Abstract

This study was performed to investigate the effect of early pressure dressing on the prevention of postoperative subdural effusion secondary to decompressive craniectomy (DC) in patients with severe traumatic brain injury (STBI). Patients with STBI who had undergone DC for refractory increased intracranial pressure between January 2008 and December 2011 (n = 169) were randomly divided into early pressure dressing (n = 82) and control (n = 87) groups. Early pressure dressing with an elastic bandage or general wrapping (control treatment) was applied 7 to 10 days after DC. Patients' age, sex, preoperative Glasgow Coma Scale score, incidence rate of subdural effusion, hospitalization time, and postoperative Glasgow Outcome Scale score were compared between groups. Intracranial pressure was measured immediately before and on the day after pressure dressing. No significant difference in age, sex, preoperative Glasgow Coma Scale score, or postoperative Glasgow Outcome Scale score was observed between groups (P > 0.05). Subdural effusion incidence rates were significantly lower in the early pressure dressing group than those in the control group (χ² = 5.449, P = 0.021), and a larger proportion of patients in the early pressure dressing group was hospitalized for 30 days or less (χ² = 5.245, P = 0.027). Early pressure dressing 7 to 10 days after DC, which is a noninvasive, simple procedure, reduced the incidence rate of subdural effusion and shortened hospitalization time after DC for STBI.

Complications of Decompressive Craniectomy

“…Early pressure dressing applied 7–10 days after DC has been shown to reduce this complication in a small randomized controlled trial ( 43 ). A tense collection of fluid can rarely cause pressure on the brain due to a ball valve effect and has been termed external brain tamponade and such hygromas require drainage ( 16 , 44 , 45 ).…”

Evidence-Based Nursing Review of Craniectomy Care

“…The placement of a pressure dressing in the immediate postoperative period is associated with decreased rate of subdural effusion in the traumatic brain injury population. 11 However, this finding needs to be studied in the patient population with stroke.…”

A Retrospective Analysis of Randomized Controlled Trials on Traumatic Brain Injury: Evaluation of CONSORT Item Adherence

“…A total of 1844 abstracts were excluded due to the following reasons: no study on TBI ( n = 785), no RCT ( n = 431), laboratory study ( n = 88), delayed intervention (e.g., study on rehabilitation techniques; n = 300), no original article ( n = 222), other reasons ( n = 18).During the further analysis of the 82 studies left, five studies had to be excluded, as the full-text revealed that the studies did not meet the criteria of RCTs; two more articles had to be excluded as the full-texts were only available in Russian/Chinese; three articles were identified as review articles. Therefore, a total of 72 articles [ 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58...…”