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Updated: Oct 10, 2025
Controlled Cortical Impact Model for Traumatic Brain Injury
Published on: August 5, 2014
Functional Short-Term Outcomes and Mortality in Children with Severe Traumatic Brain Injury: Comparing Decompressive
Nora Bruns1,2, Oliver Kamp3, Kim Lange3
1Department of Pediatrics I, Hand and Reconstructive Surgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
Insights
Decompressive craniectomy (DC) in children with severe head trauma was linked to worse short-term outcomes and higher mortality rates compared to medical management. Further research is needed to clarify DC
Area of Science:
- Pediatric Neurosurgery
- Critical Care Medicine
- Trauma Surgery
Background:
- Decompressive craniectomy (DC) effectiveness in pediatric severe head trauma is debated.
- Lack of high-quality evidence complicates clinical decision-making for neurosurgeons and pediatric intensive care physicians.
- This study addresses the need for comparative data on DC versus medical management in critically ill children.
Purpose of the Study:
- To compare the effects of decompressive craniectomy (DC) versus medical management on short-term outcomes and mortality in children with severe head trauma.
- To analyze data from a large multi-center cohort to inform clinical practice.
- To provide evidence regarding the risks and benefits of DC in pediatric head injury.
Main Methods:
- Retrospective multi-center cohort study using data from TraumaRegister DGU®.
- Inclusion criteria: patients <18 years of age with severe head trauma treated in Germany, Austria, and Switzerland over 10 years.
- Statistical analysis included descriptive and multi-variable analyses (logistic regression) to compare outcomes after DC and medical management.
Main Results:
- Out of 2507 patients, 402 (16.0%) underwent DC.
- Mortality rates were 20.6% following DC versus 13.7% with medical management.
- Poor outcomes (death or vegetative state) occurred in 27.6% after DC compared to 16.1% with medical management. Adjusted analysis showed increased odds for poor outcome (OR 1.56) after DC.
Conclusions:
- Decompressive craniectomy in children with severe head trauma is associated with increased odds of poor short-term outcomes.
- The findings suggest caution regarding the widespread use of DC in this population.
- Further high-quality randomized controlled trials are essential to definitively determine the benefits and risks of DC in pediatric severe head trauma.
Abstract:
The effect of decompressive craniectomy (DC) on functional outcomes and mortality in children after severe head trauma is strongly debated. The lack of high-quality evidence poses a serious challenge to neurosurgeons' and pediatric intensive care physicians' decision making in critically ill children after head trauma. This study was conducted to compare DC and medical management in severely head-injured children with respect to short-term outcomes and mortality. Data on patients <18 years of age treated in Germany, Austria, and Switzerland during a 10-year period were extracted from TraumaRegister DGU®, forming a retrospective multi-center cohort study. Descriptive and multi-variable analyses were performed to compare outcomes and mortality after DC and medical management. Of 2507 patients, 402 (16.0%) received DC. Mortality was 20.6% after DC and 13.7% after medical management. Poor outcome (death or vegetative state) occurred in 27.6% after DC and in 16.1% after medical management. After risk adjustment by logistic regression modeling, the odds ratio was 1.56 (95% confidence interval 1.01-2.40) for poor outcome at intensive care unit discharge and 1.20 (0.74-1.95) for mortality after DC. In summary, DC was associated with increased odds for poor short-term outcomes in children with severe head trauma. This finding should temper enthusiasm for DC in children until a large randomized controlled trial has answered more precisely if DC in children is beneficial or increases rates of vegetative state.
