Surgical treatment in traumatic brain injury with critical glasgow coma scale (GCS): clinical outcome in a single center

Abstract

Aims: The goal of this study was to analyze outcomes of the patients underwent surgery for traumatic brain injury (TBI) with critical Glasgow coma scale at Dr. Soetomo General Hospital Surabaya, Indonesia in term of mortality.Methods: All cases of critical TBI patients with hemorrhage was operated (evacuation craniotomy) from January 2015 - December 2016 at Dr. Soetomo General Hospital Surabaya, Indonesia. The data were retrospectively reviewed from the medical records. Information regarding patient age, sex, diagnoses, Glasgow Coma Scale (GCS), surgery type, and the outcome after surgery was collected and analyzed.Results: 36 samples were analyzed from the medical records of Dr. Soetomo hospital. The operation was performedfor the patients with epidural hemorrhage (EDH), subdural hemorrhage (SDH) and intracerebral hemorrhage (ICH). In the postoperative period, 83.78% (30 patients) of patients died and only 16.22% (6 patients) survived. Survived patients were followed until six months according to Glasgow Outcome Scale (GOS).As regard with the six-month evaluation of GOS, only 2 patients came out with good functional outcome (GOS Extended8), 2 patients came out with lower moderate disability (GOS Extended 5), and 2 patients with dead status (GOS Extended 1).Conclusions: In this retrospective study, overall 83.78% (30 patients) patients not survived but 16.22% (6 patients) survived. Two patients had better functional outcome after six months postoperative. The authors conclude that TBI patients with critical GCS should manage with surgery as indicated since good functional results can be obtained in some cases. Many factors affected the good and bad condition of the patient after craniotomy.Keywords: Critical GCS, hemorrhage evacuation craniotomy, GOS Extended