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Controlled Cortical Impact Model for Traumatic Brain Injury
Published on: August 5, 2014
Long Term Outcome in Survivors of Decompressive Craniectomy following Severe Traumatic Brain Injury
Ashutosh Kaushal1, Ashish Bindra1, Abhyuday Kumar2
1Department of Neuroanesthesiology and Critical Care, All India Institute of Medical Sciences and associated Jai Prakash Narain Apex Trauma Centre, New Delhi, India.
Insights
Decompressive craniectomy (DC) survivors often experience significant disability. Tracheostomy and mean arterial pressure (MAP) at admission independently predict patient outcomes after DC for severe traumatic brain injury (sTBI).
Area of Science:
- Neurosurgery
- Trauma Surgery
- Critical Care Medicine
Background:
- Decompressive craniectomy (DC) is a critical intervention for managing intracranial hypertension in severe traumatic brain injury (sTBI).
- Despite DC, many patients face mortality or severe neurological disability, necessitating further investigation into factors influencing outcomes.
Purpose of the Study:
- To assess the functional outcomes, using the Glasgow Outcome Scale-Extended (GOSE), in patients who survived DC for sTBI.
- To identify correlations between admission and hospital-related factors and the functional outcomes of DC survivors.
Main Methods:
- An observational study prospectively enrolled 85 patients (15-65 years) undergoing cranioplasty after DC for sTBI.
- Data collected included demographics, clinical details, GOSE, Marshalls grading, Glasgow Coma Score (GCS), motor response, mean arterial pressure (MAP), and timing of DC.
- Retrospective data were obtained from hospital records, and functional outcomes were assessed at admission for cranioplasty.
Main Results:
- Of 85 patients, 36% (n=31) had good functional outcome (GOSE 5-8), while 64% (n=54) had poor outcome (GOSE 1-4).
- Univariate analysis showed 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.
- Multivariate analysis identified MAP at admission (OR [95% CI]; 0.07 [0.01-0.40]) and tracheostomy (OR [95% CI]; 15 [1.45-162.9]) as independent predictors of functional outcome.
Conclusions:
- Survivors of decompressive craniectomy for severe traumatic brain injury frequently experience significant functional disability.
- Tracheostomy and mean arterial pressure on admission are independently associated with patient outcomes following DC.
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.
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