Outcome following decompressive craniectomy in children with severe traumatic brain injury: a 10-year single-center experience with long-term follow up

Jagannathan, Jay; Okonkwo, David O.; Dumont, Aaron S.; Ahmed, Hazem; Bahari, Abbas; Prevedello, Daniel M.; Jane, John A.

doi:10.3171/ped.2007.106.4.268

Cited by 104 publications

(119 citation statements)

References 31 publications

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“…In a study of 23 patients younger than 19 years of age, Jagannathan et al reported that children with TBI who were treated with DC had a favorable outcome, with a mean GOS score of 4.2 at follow-up. 10 In a study of 14 children with severe TBI, Pérez Suárez et al also reported a favorable outcome, with a mean GOS score of 4.4 (range 4-5) at the 2-year follow-up. 17 In our study the majority of our patients who were treated with DC had a favorable GOS score.…”

Section: % (5/17mentioning

confidence: 99%

Outcome of children with severe traumatic brain injury who are treated with decompressive craniectomy

Mhanna

Mallah

Verrees³

et al. 2015

PED

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OBJECT Decompressive craniectomy (DC) for the management of severe traumatic brain injury (TBI) is controversial. The authors sought to determine if DC improves the outcome of children with severe TBI. METHODS In a retrospective, case-control study, medical records of all patients admitted to the pediatric ICU between May 1998 and May 2008 with severe TBI and treated with DC were identified and matched to patients who were treated medically without DC. Medical records were reviewed for patients’ demographic data and baseline characteristics. RESULTS During the study period, 17 patients with severe TBI treated with DC at a median of 2 hours (interquartile range [IQR] 1–14 hours) after admission were identified and matched to 17 contemporary controls. On admission, there were no differences between DC and control patients regarding age (10.2 ± 5.9 years vs 12.4 ± 5.4 years, respectively [mean ± SD]), sex, weight, Glasgow Coma Scale score (median 5 [IQR 3–7] vs 4 [IQR 3–6], respectively; p = 0.14), or the highest intracranial pressure (median 42 [IQR 22–54] vs 30 [IQR 21–36], respectively; p = 0.77). However, CT findings were significant for a higher rate of herniation and cerebral edema among patients with DC versus controls (7/17 vs 2/17, respectively, had herniation [p = 0.05] and 14/17 vs 6/17, respectively, had cerebral edema [p = 0.006]). Overall there were no significant differences in survival between patients with DC and controls (71% [12/17] vs 82% [14/17], respectively; p = 0.34). However, among survivors, at 4 years (IQR 1–6 years) after the TBI, 42% (5/12) of the DC patients had mild disability or a Glasgow Outcome Scale score of 5 vs none (0/14) of the controls (p = 0.012). CONCLUSIONS In this retrospective, small case-control study, the authors have shown that early DC in pediatric patients with severe TBI improves outcome in survivors. Future prospective randomized controlled studies are needed to confirm these findings.

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confidence: 99%

Outcome of children with severe traumatic brain injury who are treated with decompressive craniectomy

Mhanna

Mallah

Verrees³

et al. 2015

PED

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“…12,23,37 The renewed interest in decompressive craniectomy in the management of TBI is evidenced by 2 clinical trials currently underway-the RESCUEicp (Randomized Evaluation of Surgery for Uncontrollable Elevation of Intracranial Pressure) trial 19 and the DECRA (DEcompressive CRAniectomy) trial. 34 There have been several reports on decompressive craniectomy in children with TBI, 1,12,20,23,25,37 but few have specifically addressed its efficacy with nonaccidental or inflicted head trauma.…”

Section: Discussionmentioning

confidence: 99%

Comparison of outcomes following decompressive craniectomy in children with accidental and nonaccidental blunt cranial trauma

Oluigbo¹,

Wilkinson²,

Stence³

et al. 2012

PED

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Object The goal of this study was to compare clinical outcomes following decompressive craniectomy performed for intracranial hypertension in children with nonaccidental, blunt cranial trauma with outcomes of decompressive craniectomy in children injured by other mechanisms. Methods All children in a prospectively acquired database of trauma admissions who underwent decompressive craniectomy over a 9-year span, beginning January 1, 2000, are the basis for this study. Clinical records and neuroimaging studies were systematically reviewed. Results Thirty-seven children met the inclusion criteria. Nonaccidental head trauma was the most common mechanism of injury (38%). The mortality rate in patients with abusive brain injury (35.7%) was significantly higher (p < 0.05) than in patients with other causes of traumatic brain injury (4.3%). Children with inflicted head injuries had a 12-fold increase in the odds of death and 3-fold increase in the odds of a poor outcome (King's Outcome Scale for Closed Head Injury score of 1, 2, or 3). Conclusions Children with nonaccidental blunt cranial trauma have significantly higher mortality following decompressive craniectomy than do children with other mechanisms of injury. This understanding can be interpreted to mean either that the threshold for decompression should be lower in children with nonaccidental closed head injury or that decompression is unlikely to alter the path to a fatal outcome. If decompressive craniectomy is to be effective in reducing mortality in the setting of nonaccidental blunt cranial trauma, it should be done quite early.

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“…Several studies including a recent report directly assessing the various methods have suggested the frontooccipital horn ratio may better serve as an estimate of ventricular volume in those for whom there is concern for hydrocephalus. 16 Pediatric patients with TBI can develop delayed hydrocephalus: 20% of patients with severe injuries, 13 29.5% after a decompressive craniectomy (accidental trauma), 7 and 40% of patients with pediatric TBI (accidental and nonaccidental trauma). 9 It's unclear from these studies what the natural history of developing hydrocephalus is in the NAHT population.…”

Section: Discussionmentioning

confidence: 99%

Hydrocephalus associated with childhood nonaccidental head trauma

Vadivelu

Rekate

Esernio-Jenssen

et al. 2016

FOC

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OBJECTIVE The incidence of posttraumatic ventriculomegaly (PTV) and shunt-dependent hydrocephalus after nonaccidental head trauma (NAHT) is unknown. In the present study, the authors assessed the timing of PTV development, the relationship between PTV and decompressive craniectomy (DC), and whether PTV necessitated placement of a permanent shunt. Also, NAHT/PTV cases were categorized into a temporal profile of delay in admission and evaluated for association with outcomes at discharge. METHODS The authors retrospectively reviewed the cases of patients diagnosed with NAHT throughout a 10-year period. Cases in which sequential CT scans had been obtained (n = 28) were evaluated for Evans' index to determine the earliest time ventricular dilation was observed. Discharge outcomes were assessed using the King's Outcome Scale for Childhood Head Injury score. RESULTS Thirty-nine percent (11 of 28) of the patients developed PTV. A low admission Glasgow Coma Scale (GCS) score predicted early PTV presentation (within < 3 days) versus a high GCS score (> 1 week). A majority of PTV/NAHT patients presented with a subdural hematoma (both convexity and interhemispheric) and ischemic stroke, but subarachnoid hemorrhage was significantly associated with PTV/NAHT (p = 0.011). Of 6 patients undergoing a DC for intractable intracranial pressure, 4 (67%) developed PTV (p = 0.0366). These patients tended to present with lower GCS scores and develop ventriculomegaly early. Only 2 patients developed hydrocephalus requiring shunt placement. CONCLUSIONS PTV presents early after NAHT, particularly after a DC has been performed. However, the authors found that only a few PTV/NAHT patients developed shunt-dependent hydrocephalus.

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Outcome following decompressive craniectomy in children with severe traumatic brain injury: a 10-year single-center experience with long-term follow up

Abstract: Although the mortality rate for children with severe TBI remains high, decompressive craniectomy is effective in reducing ICP and is associated with good outcomes in surviving patients.

Cited by 104 publications

References 31 publications

Outcome of children with severe traumatic brain injury who are treated with decompressive craniectomy

Outcome of children with severe traumatic brain injury who are treated with decompressive craniectomy

Comparison of outcomes following decompressive craniectomy in children with accidental and nonaccidental blunt cranial trauma

Hydrocephalus associated with childhood nonaccidental head trauma

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