Long term outcome in survivors of decompressive craniectomy following severe traumatic brain injury

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.

Long-Term Results of Neurological Outcome, Quality of Life, and Cosmetic Outcome After Cranioplastic Surgery: A Single Center Study of 202 Patients

“…To the best of our knowledge, long-term results for CP patients have not been reported yet. Only a few short- or mid-term results up to 30 months in DC patients following TBI have been reported so far ( 21 – 24 ). The rate of good recovery ranged between 36 and 64.8% ( 21 , 22 , 24 ).…”

“…Only a few short- or mid-term results up to 30 months in DC patients following TBI have been reported so far ( 21 – 24 ). The rate of good recovery ranged between 36 and 64.8% ( 21 , 22 , 24 ). In a similar heterogenous patient population ( n = 204), a favorable outcome 1 year after DC was observed in 34% of patients and furthermore, a high variety of factors that had an impact on outcome parameters was reported ( 25 ).…”

Glasgow Coma Scale Motor Score Predicts Need for Tracheostomy After Decompressive Craniectomy for Traumatic Brain Injury

“… 11 13 17 19 20 25) Decompressive craniectomies are performed for a variety of indications in severe TBI such as alleviating elevated intracranial pressure (ICP) secondary to intracranial hemorrhages (ICH) and in cases of diffuse TBI with medically refractory elevated ICP without a mass lesion. 8 14 16 21) Unfortunately, many patients with severe TBI who have undergone decompressive craniectomy ultimately have poor functional outcomes with up to 62% of patients requiring a tracheostomy prior to discharge. 21) The need for mechanical ventilatory support via an endotracheal tube holds patients in an elevated level of care such as an intensive care unit (ICU) while waiting for successful extubation or tracheostomy for definitive airway management which increases healthcare cost and resource utilization.…”

“… 8 14 16 21) Unfortunately, many patients with severe TBI who have undergone decompressive craniectomy ultimately have poor functional outcomes with up to 62% of patients requiring a tracheostomy prior to discharge. 21) The need for mechanical ventilatory support via an endotracheal tube holds patients in an elevated level of care such as an intensive care unit (ICU) while waiting for successful extubation or tracheostomy for definitive airway management which increases healthcare cost and resource utilization. There have been several studies that show benefits of early tracheostomy in patients with neurologic injury such as TBI, stroke, and spontaneous ICH.…”