Decompressive Craniectomy and Outcomes in Severe Traumatic Brain Injury in Children and Adolescent Patients.

Abstract

Decompressive craniectomy has been used to reduce the increased intracranial pressure (ICP) in severe traumatic brain injury (TBI). However, recent retrospective studies showed conflicting results regarding the benefit of decompressive craniectomy in children. Owing to the gap in information, we designed a study to examine the long-term outcomes of decompressive craniectomy. This study was performed from data obtained from the Approaches and Decisions in Acute Pediatric TBI Trial. Included in the study were all patients younger than 18 years with severe TBI (Glasgow Coma Scale Score ≤8) that had hourly ICP measurements ≥20 mm Hg for 2 consecutive hours during the first 7 intensive care unit days. Patients were divided into groups based on whether they underwent decompressive craniectomy after 2 consecutive hours of ICP ≥20 mm Hg or continued to receive medical management. The data for this study were obtained from the Federal Interagency Traumatic Brain Injury Research Informatics System. Propensity score matching was used to compare decompressive craniectomy with medical management. The primary outcome was 6-month Glasgow Outcome Scale-Extended score. Of the 465 patients who qualified for the study, 403 (86.7%) underwent medical management and 62 (13.3%) underwent decompressive craniectomy. Pair-matched analysis did not show any significant difference between the 2 groups in 6-month Glasgow Outcome Scale-Extended score (favorable, 50.0% vs 58.8%, P = .661) and in upper good recovery (11.4% vs 20.5%), lower good recovery (2.3% vs 11.4%), upper moderate disability (9.1% vs 13.6%), lower moderate disability (9.1% vs 0.0%), upper severe disability (15.9% vs 11.4%), lower severe disability (27.3% vs 15.9%), vegetative state (4.5% vs 0.0%), and death (20.5% vs 27.3%). There was no significant difference in neurological function at 6 months between patients who did and did not undergo decompressive craniectomy after severe TBI.