Severe Traumatic Brain Injury Requiring Surgical Decompression in the Young Adult: Factors Influencing Morbidity and Mortality – A Retrospective Analysis

Ogunlade, John; Elia, Chris; Duong, Jason; Yanez, Paulino; Dong, Fanglong; Wacker, Margaret Rose; Menoni, Rosalinda; Goldenberg, Todd M.; Miulli, Dan E

doi:10.7759/cureus.3042

Cited by 10 publications

(12 citation statements)

References 19 publications

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“…According to the literature, factors associated withmortality are age, the low-GCS score at admission, the size of the craniectomy, effacement of basal cisterns, and severe midline shift. 13 16 22 23 24 Unfavorable outcomes reported were low-GCS scores on admission, postoperative hydrocephalus, tracheostomy, sphenoid fractures, and unchanged ICP. 21 25 26 …”

Section: Discussionmentioning

confidence: 99%

“… 16 20 21 22 24 25 26 27 In-hospital mortality rates ranged between 32 to 55%, 20 21 26 whereas 30-day mortality rates ranged from 12 to 28.3%. 16 22 24 27 Laghari et al reported an in-hospital mortality rate of 25% at 3 months in their series. In addition, Khalili reported a mortality rate of 40.8% at 1-year follow-up.…”

Section: Discussionmentioning

confidence: 99%

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Decompressive Craniectomy for Traumatic Brain Injury: In-hospital Mortality-Associated Factors

Celi

Saal‐Zapata

2020

JNRP

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Objective Determine predictors of in-hospital mortality in patients with severe traumatic brain injury (TBI) who underwent decompressive craniectomy. Materials and Methods This retrospective study reviewed consecutive patients who underwent a decompressive craniectomy between March 2017 and March 2020 at our institution, and analyzed clinical characteristics, brain tomographic images, surgical details and morbimortality associated with this procedure. Results Thirty-three (30 unilateral and 3 bifrontal) decompressive craniectomies were performed, of which 27 patients were male (81.8%). The mean age was 52.18 years, the mean Glasgow coma scale (GCS) score at admission was 9, and 24 patients had anisocoria (72.7%). Falls were the principal cause of the trauma (51.5%), the mean anterior–posterior diameter (APD) of the bone flap in unilateral cases was 106.81 mm (standard deviation [SD] 20.42) and 16 patients (53.3%) underwent a right-sided hemicraniectomy. The temporal bone enlargement was done in 20 cases (66.7%), the mean time of surgery was 2 hours and 27 minutes, the skull flap was preserved in the subcutaneous layer in 29 cases (87.8%), the mean of blood loss was 636.36 mL,and in-hospital mortality was 12%. Univariate analysis found differences between the APD diameter (120.3 mm vs. 85.3 mm; p = 0.003) and the presence of midline shift > 5 mm (p = 0.033). Conclusion The size of the skull flap and the presence of midline shift > 5 mm were predictors of mortality. In the absence of intercranial pressure (ICP) monitoring, clinical and radiological criteria are mandatory to perform a decompressive craniectomy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Decompressive Craniectomy for Traumatic Brain Injury: In-hospital Mortality-Associated Factors

Celi

Saal‐Zapata

2020

JNRP

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“…A retrospective review on postsurgical outcomes of patients with severe TBI found that individuals presenting with a GCS score of 3-5 were nearly 5 times more likely to have a poor outcome at 30 days compared to patients with a GCS score of 6-8. 16 Cooper et al, in a prospective randomized controlled trial, found that patients with severe TBI receiving decompressive craniectomy compared to the standard level of care had higher odds of unfavorable outcome and similar death rates at 6 months. 4 These previous findings, along with our data, should encourage research on the reprioritization of care to patients with less severe injuries, a drastic change to the traditional practice in which the most severely injured patients are prioritized for care.…”

Section: Impact Of Surgerymentioning

confidence: 99%

An evaluation of outcomes in patients with traumatic brain injury at a referral hospital in Tanzania: evidence from a survival analysis

Elahi

Rocha

Silva

et al. 2019

Neurosurgical Focus

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OBJECTIVEThe purpose of this study was to determine if patients with traumatic brain injury (TBI) in low- and middle-income countries who receive surgery have better outcomes than patients with TBI who do not receive surgery, and whether this differs with severity of injury.METHODSThe authors generated a series of Kaplan-Meier plots and performed multiple Cox proportional hazard models to assess the relationship between TBI surgery and TBI severity. The TBI severity was categorized using admission Glasgow Coma Scale scores: mild (14, 15), moderate (9–13), or severe (3–8). The authors investigated outcomes from admission to hospital day 14. The outcome considered was the Glasgow Outcome Scale–Extended, categorized as poor outcome (1–4) and good outcome (5–8). The authors used TBI registry data collected from 2013 to 2017 at a regional referral hospital in Tanzania.RESULTSOf the final 2502 patients, 609 (24%) received surgery and 1893 (76%) did not receive surgery. There were significantly fewer road traffic injuries and more violent causes of injury in those receiving surgery. Those receiving surgery were also more likely to receive care in the ICU, to have a poor outcome, to have a moderate or severe TBI, and to stay in the hospital longer. The hazard ratio for patients with TBI who underwent operation versus those who did not was 0.17 (95% CI 0.06–0.49; p < 0.001) in patients with moderate TBI; 0.2 (95% CI 0.06–0.64; p = 0.01) for those with mild TBI, and 0.47 (95% CI 0.24–0.89; p = 0.02) for those with severe TBI.CONCLUSIONSThose who received surgery for their TBI had a lower hazard for poor outcome than those who did not. Surgical intervention was associated with the greatest improvement in outcomes for moderate head injuries, followed by mild and severe injuries. The findings suggest a reprioritization of patients with moderate TBI—a drastic change to the traditional practice within low- and middle-income countries in which the most severely injured patients are prioritized for care.

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“…Studies on adults without any age limit have shown that the 30-day mortality rates ranged from 15.3 to 31.5% 5,6 . In young adults between the ages of 18 and 30 years, the 30-day mortality rate has been reported to be 12% 7 . In this study, 7-and 30-day mortality rates were 20.9 and 44.5%, respectively, which are higher than the rates demonstrated in other studies.…”

Section: Discussionmentioning

confidence: 99%

Relationship between platelet indices and red cell distribution width and short-term mortality in traumatic brain injury with 30-day mortality

Palabıyık

Tomak

Acar

et al. 2023

Rev. Assoc. Med. Bras.

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OBJECTIVE:This study aimed at investigating whether there is a relationship between 7-or 30-day mortality and mean platelet volume, platelet distribution width, platelet count-to-total lymphocyte count ratio, or red cell distribution width in patients with traumatic brain injury. METHODS: We retrospectively analyzed intensive care unit patients with traumatic brain injury. We recorded patients' ages; genders; diagnoses; Glasgow Coma Scale scores; length of intensive care unit stay (in days); mean platelet volume, platelet distribution width, platelet count-to-total lymphocyte count ratio, and red cell distribution width values upon hospital admission; and health on the 7th and 30th days of their stays. RESULTS: We analyzed data from 110 patients. Of these, 84 (76.4%) were male and 26 (23.6%) were female. On the 7-and 30-day mortality evaluations, compared to the living patients, the deceased patients had a significantly higher median age and a significantly lower median Glasgow Coma Scale. Thus, increased age and lower Glasgow Coma Scale scores were associated with increased 7-and 30-day mortality rates. mean platelet volume and platelet distribution width values were similar in living and deceased patients. platelet count-to-total lymphocyte count ratio values were lower in deceased patients, but this difference was not statistically significant. Within 30 days after traumatic brain injury, deceased patients' red cell distribution width values were significantly elevated in deceased patients compared to those of living patients. CONCLUSION: Mean platelet volume, platelet distribution width, and platelet count-to-total lymphocyte count ratio values were not associated with 7-and 30-day mortality, whereas only elevated red cell distribution width was associated with 30-day mortality.

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Severe Traumatic Brain Injury Requiring Surgical Decompression in the Young Adult: Factors Influencing Morbidity and Mortality – A Retrospective Analysis

Cited by 10 publications

References 19 publications

Decompressive Craniectomy for Traumatic Brain Injury: In-hospital Mortality-Associated Factors

Decompressive Craniectomy for Traumatic Brain Injury: In-hospital Mortality-Associated Factors

An evaluation of outcomes in patients with traumatic brain injury at a referral hospital in Tanzania: evidence from a survival analysis

Relationship between platelet indices and red cell distribution width and short-term mortality in traumatic brain injury with 30-day mortality

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