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Asian J Neurosurg. 2019 Jan-Mar;14(1):52-57. doi: 10.4103/ajns.AJNS_147_17.

Long Term Outcome in Survivors of Decompressive Craniectomy following Severe Traumatic Brain Injury.

Author information

1
Department of Neuroanesthesiology and Critical Care, All India Institute of Medical Sciences and associated Jai Prakash Narain Apex Trauma Centre, New Delhi, India.
2
Department of Anesthesiology, Critical Care and Pain Medicine, All India Institute of Medical Sciences and associated Jai Prakash Narain Apex Trauma Centre, New Delhi, India.
3
Department of Neurosurgery, All India Institute of Medical Sciences and associated Jai Prakash Narain Apex Trauma Centre, New Delhi, India.

Abstract

Background:

Decompressive craniectomy (DC) is done for the management of intracranial hypertension due to severe traumatic brain injury (sTBI). Despite DC, a number of patients die and others suffer from severe neurological disability. We conducted this observational study to assess functional outcome as measured by Glasgow outcome scale-extended (GOSE) in survivors of DC. The correlation between various factors at admission and hospital with functional outcome was also obtained.

Materials and Methods:

Patients (15-65 years) posted for cranioplasty following DC due to sTBI were prospectively enrolled. Demographic profile, clinical data, and GOSE were noted at the time of admission for cranioplasty from the patient or nearest relative or both. Retrospective data noted from hospital records included admission Marshalls grading, Glasgow coma score (GCS), motor response, mean arterial pressure (MAP), and timing of DC at the time of initial admission following sTBI.

Results:

A total of 85 patients (71 males and 14 females) were enrolled over a period of 2 years. The mean age of the patients was 33.42 ± 12.70 years. The median GCS at the time of admission due to head injury, at the time of discharge, and at the time of cranioplasty was 8 (interquartile range [IQR] 3-15), 10 (IQR 4-15), and 15 (IQR 7-15), respectively. Thirty-one patients (36%) had good functional outcome (GOSE 5-8) and 54 patients (64%) had poor functional outcome (GOSE 1-4). On univariate analysis tracheostomy (P = 0.00), duration of hospital stay (P = 0.002), MAP at admission (P = 0.01), and GCS at discharge (P = 0.01) correlated with outcome [Table 1]. On multivariate analysis MAP at admission (odds ratio [OR] [95% confidence interval {CI}]; 0.07 [0.01-0.40] and tracheostomy (OR [95% CI]; 15 [1.45-162.9]) were found to be the independent predictors of functional outcome.

Conclusion:

Significant disability is seen among the survivors of DC. Tracheostomy and MAP at admission were found to be independently associated with the patient outcome.

KEYWORDS:

Glasgow coma scale; decompressive craniectomy; extended Glasgow outcome score; functional outcome; mean arterial pressure

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