Decompressive craniectomy for neurotrauma: the limitations of applying an outcome prediction model.

Abstract

There is currently much interest in the use of decompressive craniectomy for patients with severe head injury. A number of studies have demonstrated that not only can the technique lower intracranial pressure but can also improve outcome. Whilst many patients who would otherwise have died or had a poor outcome now go on to make a good recovery, there is little doubt that complications can have a very significant impact on long term outcome. By using the corticosteroid randomisation after significant head injury (CRASH) collaborators outcome prediction model, three patients were selected who had a similar outcome prediction. All three patients developed intracranial hypertension following trauma and had a decompressive craniectomy. Despite having a similar outcome prediction only one patient made an uneventful recovery. The remaining two patients suffered significant complications. This report illustrates the potential clinical applications and limitations of an outcome prediction model and demonstrates the impact that complications can have on eventual outcome.