Emergency decompressive craniectomy for trauma patients with Glasgow Coma Scale of 3 and bilateral fixed dilated pupils

Jamous, Mohammad; Barbarawi, Mohammed M Al; Samrah, Shaher; Khabaz, Mohamad Nidal; Al-Jarrah, Muhammed; Dauod, S.

doi:10.1007/s00068-010-0002-4

Cited by 14 publications

(10 citation statements)

References 30 publications

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“…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 …”

Section: Discussionmentioning

confidence: 99%

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

Patton

Moore

Farhat

et al. 2020

Int. J. Clin. Pract.

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Background: Guidelines for injury care are increasingly moving away from surgical management towards less invasive procedures but there is a knowledge gap on how these recommendations are influencing practice. We aimed to assess inter-hospital variation in surgical intensity for injury admissions and evaluate the correlation between hospital surgical intensity and mortality/complications. Methods: We included adults admitted for major trauma between 2006 and 2016 in a Canadian provincial trauma system. Analyses were stratified for orthopaedic (n = 16 887), neurological (n = 12 888) and torso injuries (n = 9816). Surgical intensity was quantified with the number of surgical procedures <72 hours. Inter-hospital variation was assessed with the intra-class correlation coefficient (ICC). We assessed the correlation between the risk-adjusted mean number of surgical procedures and risk-adjusted incidence of mortality and complications using Pearson correlation coefficients (r). Results: Moderate inter-hospital variation was observed for orthopaedic surgery (ICC = 14.0%) whereas variation was low for torso surgery (ICC = 2.7%) and neurosurgery (ICC = 0.8%). Surgical intensity was negatively correlated with hospital mortality for torso injury (r = −.32, P = .02) and neurotrauma (r = −.65, P = .08). A strong positive correlation was observed with hospital complications for orthopaedic injuries (r = .36, P = .006) whereas the opposite was observed for neurotrauma (r = −.71, P = .05). Conclusions: Results should be interpreted with caution as they may be a result of residual confounding. However, they may suggest that there are opportunities for quality improvement in surgical care for injury admissions, particularly for orthopaedic injuries. Moving forward, we should aim to prospectively evaluate adherence to guidelines on non-operative management and their impact on mortality and morbidity.

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Section: Discussionmentioning

confidence: 99%

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

Patton

Moore

Farhat

et al. 2020

Int. J. Clin. Pract.

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“…At 6 months, patients were assessed and then deemed to have either a favourable (moderate disability or good recovery) or unfavourable (death, persistent vegetative state or severe disability) outcome. Patients in the DC group had 42% favourable outcomes (58% unfavourable) compared to Kirby: Decompressive craniectomy in the emergency setting Australasian Journal of Paramedicine: 2017;14 (1) 45% in the CR group (55% unfavourable). The overall results were not significant and the authors concluded that the rate of unfavourable outcomes in DC was high as patients with more severe TBIs were in the DC group; once injury severity was accounted for the outcomes are quite similar (17).…”

Section: Decompressive Craniectomy Versus Craniotomymentioning

confidence: 95%

“…Jamous et al argued that DC in these patients did not only prove unsuccessful, but prolonged the suffering of the patients and affected families. The authors of the study decided the 100% mortality rate was most likely due to the level of brain injury and these patients likely had no chance of survival regardless of treatment (1). These results should lead to further discussion regarding the exclusion of patients with a GCS score of 3.…”

Section: Indications and Outcomesmentioning

confidence: 99%

“…Traumatic brain injury (TBI) is a leading cause of disability and death, with the highest incidence occurring in young males. Raised intracranial pressure (ICP) caused from the TBI is responsible for a large majority of these deaths and disabilities (1,2). The most definitive form of current treatment for increased ICP is decompressive craniectomy (DC).…”

Section: Introductionmentioning

confidence: 99%

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Decompressive Craniectomy in the Emergency Setting: A Historical Review, Summary of Published Evidence and Review of Implications for Pre-Hospital Emergency Care

Kirby

Burchell

Taylor

2017

Australasian Journal of Paramedicine

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Introduction: Decompressive Craniectomies (DC) are a controversial treatment for increased intracranial pressure resulting from traumatic head injuries. The technique has been around for approximately 5000 years, but only now are researchers beginning to unlock its true potential. This article aims to summarize history, review current knowledge and identify the implications of pre-hospital emergency care. Methods: An electronic search was conducted using the databases; Medline (via EBSCOHost), BioMed Central and Cochrane Database of Systematic Reviews.Results: 131 articles were identified. Articles that were excluded from analysis; those unavailable as full text, not available in English and review articles. 19 articles were included in analysis. Conclusion: Decompressive Craniectomies is a comparable treatment to alternative techniques. Until recently mortality rates have been misinterpreted and unfairly reported due to the severity of brain injuries patients had already suffered. Timing of DC is a crucial factor of patient outcome, and it is of popular belief that the best chance of optimal recovery relies on a reduced injury to treatment time.

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“…Recent basic science and clinical research has advanced the treatment of spinal cord injury (Esposito et al, 2011;Ha et al, 2011). Different methods have been used to treat patients with spinal cord injury and have achieved some effect (Lemcke et al, 2010;Jamous et al, 2010). However, treatments remain unsatisfactory, partially because the mechanisms of ASCI remain unclear, thereby preventing the development of improved therapeutics.…”

Section: Introductionmentioning

confidence: 99%

Neuroprotective effect of ketamine on acute spinal cord injury in rats

Tang¹,

Yu²,

Li³

et al. 2015

Genet. Mol. Res.

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ABSTRACT. The aim of this study was to investigate the neuroprotective effects of ketamine during acute spinal cord injury in rats. Sprague Dawley (SD) rats (N = 70) were randomly divided into three groups: sham-operated (N = 10), control (N = 30), and treatment (N = 30) groups. The moderate spinal cord injury model was established. After injury, the sham-operated group received no drug, the treatment group received intraperitoneal ketamine injections, and the control group received intraperitoneal normal saline injections. Serum levels of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and spinal cord malondialdehyde (MDA) were assessed, and nerve cell apoptosis was evaluated in each group at varying time points. After spinal cord injury, TNF-α, IL-6, and MDA levels, and the number of TUNEL-positive cells among 2500 cells significantly increased (P < 0.05). Further, compared with the control group, the treatment group showed significantly lower TNF-α, IL-6, and MDA levels, and fewer TUNEL-positive cells among 2500 cells at each time point (P < 0.05). Our data indicate that ketamine exerts a neuroprotective effect on injured spinal cord.

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Emergency decompressive craniectomy for trauma patients with Glasgow Coma Scale of 3 and bilateral fixed dilated pupils

Cited by 14 publications

References 30 publications

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

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

Decompressive Craniectomy in the Emergency Setting: A Historical Review, Summary of Published Evidence and Review of Implications for Pre-Hospital Emergency Care

Neuroprotective effect of ketamine on acute spinal cord injury in rats

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