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Updated: Sep 29, 2025
Controlled Cortical Impact Model for Traumatic Brain Injury
Published on: August 5, 2014
Severe Traumatic Brain Injury in children-paradigm of decompressive craniectomy compared to a historic cohort
Vanessa Hubertus1, Tobias Finger2, Ricarda Drust2
1Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
Insights
Severe traumatic brain injury (TBI) in children treated with decompressive craniectomy (DC) showed similar favorable outcomes across different pediatric intensive care unit (ICU) setups over two decades. Continued focused therapy is key for positive results in pediatric TBI patients.
Area of Science:
- Pediatric neurosurgery
- Pediatric critical care
- Neurotraumatology
Background:
- Traumatic brain injury (TBI) is a major cause of childhood death and disability.
- Current medical therapies for severe TBI are limited, making interventions like decompressive craniectomy (DC) crucial for managing elevated intracranial pressure (ICP).
- Data on the efficacy of DC in pediatric populations with severe TBI is scarce.
Purpose of the Study:
- To evaluate the clinical outcomes of severe TBI in children treated with DC across two distinct care settings within the same academic institution.
- To compare outcomes between a recent cohort (2008-2018) and a historical cohort (1996-2007) of pediatric severe TBI patients.
Main Methods:
- Retrospective analysis of 48 pediatric patients (≤16 years) with severe TBI (GCS ≤ 8) treated between 2008 and 2018 in a pediatric ICU.
- Comparison with a historical cohort of 53 pediatric severe TBI patients treated between 1996 and 2007 in a neuro-ICU.
- Outcome assessment using the Glasgow Outcome Scale (GOS) at 3, 12, and 36 months post-treatment.
Main Results:
- Eleven patients underwent DC between 2008 and 2018.
- Despite younger patients and worse initial Glasgow Coma Scale (GCS) scores in the recent cohort, in-hospital mortality and clinical outcomes remained similar to the historical group.
- A trend towards more aggressive external ventricular drain (EVD) placement and a shift in treatment paradigms within the specialized pediatric ICU were observed.
Conclusions:
- Over two decades, pediatric severe TBI patients treated in different settings showed comparable and generally favorable clinical outcomes.
- Consistent and focused therapeutic strategies are essential to optimize outcomes for children with severe TBI.
Purpose:
Traumatic brain injury (TBI) is one of the leading causes of death and disability in children. Medical therapy remains limited, and decompressive craniectomy (DC) is an established rescue therapy in case of elevated intracranial pressure (ICP). Much discussion deals with clinical outcome after severe TBI treated with DC, while data on the pediatric population is rare. We report our experience of treating severe TBI in two different treatment setups at the same academic institution.
Methods:
Forty-eight patients (≤ 16 years) were hospitalized with severe TBI (GCS ≤ 8 points) between 2008 and 2018 in a pediatric intensive care unit (ICU) at a specialized tertiary pediatric care center. Data on treatment, clinical status, and outcome was retrospectively analyzed. Outcome data included Glasgow Outcome Scale (GOS) at 3-, 12-, and 36-month follow-up. Data was compared to a historic cohort with 53 pediatric severe TBI patients treated at the same institution in a neurointensive care unit between 1996 and 2007. Ethical approval was granted (EA2/076/21).
Results:
Between 2008 and 2018, 11 patients were treated with DC. Compared to the historic cohort, patients were younger and GCS was worse, while in-hospital mortality and clinical outcome remained similar. A trend towards more aggressive EVD placement and the internal paradigm change for treatment in a specialized pediatric ICU was observed.
Conclusions:
In children with severe TBI treated over two decades, clinical outcome was comparable and mostly favorable in two different treatment setups. Consequent therapy is warranted to maintain the positive potential for favorable outcome in children with severe TBI.
