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Published on: June 10, 2020
Determinants affecting the prognosis of decompressive craniectomy for traumatic brain injury
Haitao Jiang1, Guangshan Hao2, Rui Zhang3
1Haitao Jiang, Department of Neurosurgery, Shandong Provincial Hospital affiliated to Shandong University, 324 Jingwuweiqi Road, Jinan, 250012, China. Department of Neurosurgery, Liaocheng People's Hospital, 67 Dongchangxi Road, Liaocheng, 252000, China.
Objective:
This research was designed to investigate the prognostic determinants of patients with traumatic brain injury (TBI) undergoing decompressive craniectomy (DC).
Methods:
The present study was a retrospective single center research including a total of 112 patients undergoing DC for TBI in Liaocheng People's Hospital between January 2017 and December 2018. The results were measured by Extended Glasgow Outcome Sale (GOSE). The prognostic determinants were identified by univariate and binary logistic regression analysis between the deaths and survivors or favorable and unfavorable outcomes.
Results:
At the six-month follow-up, the mortality was 45.5% including 37 (33.0%) patients died within 30 days. The independent prognostic factors of 30-day mortality were age (p=0.033), D-dimer level at admission (p=0.032) and postoperative hypernatremia (p=0.014). Seventy five patients survived more than 30 days after DC, among which 27 (36.0%) patients had unfavorable prognosis (GOSE 1-4) and 48 (64.0%) patients presented favorable prognosis (GOSE 5-8). After 30 days from DC, the occurrence of post-traumatic hydrocephalus(PTH) (p= 0.008) was associated with unfavorable prognosis.
Conclusions:
Although DC is an effective treatment for TBI patients, the mortality and morbidity risk remain high. A combination of age, D-dimer level at admission and postoperative hypernatremia may be a good prognostic factor for 30-day mortality. Developing an accurate therapy strategy to prevent and control PTH may be beneficial to the 6-month prognosis for TBI patients undergoing DC.
