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Published on: August 5, 2014
Long-Term Pediatric Outcomes of Decompressive Craniectomy after Severe Traumatic Brain Injury
Claudia M Ocasio-Rodríguez1, Anabel Puig-Ramos1, Ricardo García-De Jesús1
1Department of Pediatrics Critical Care, School of Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico.
Insights
Early decompressive craniectomy (DC) in pediatric severe traumatic brain injury (sTBI) patients improved survival and functional outcomes. This study highlights the benefits of timely intervention for sTBI management.
Area of Science:
- Neurosurgery
- Pediatric Critical Care
- Trauma Surgery
Background:
- Decompressive craniectomy (DC) use in severe traumatic brain injury (sTBI) lacks consensus.
- Pediatric sTBI management requires further investigation into surgical interventions.
Purpose of the Study:
- To evaluate pediatric sTBI patient profiles.
- To assess functional outcomes 6 months post-trauma comparing DC versus no DC.
- To compare functional outcomes of early versus late DC procedures.
Main Methods:
- Case-control observational study of pediatric patients with sTBI (Glasgow Coma Scale ≤ 8).
- Inclusion criteria: admission within 24 hours of injury.
- Functional outcomes measured using Glasgow Outcome Scale Extended Pediatric (GOS-E Peds) at 6 months.
Main Results:
- 20 patients included: 15 DC, 5 control. No significant differences in demographics or initial injury severity scores.
- Higher incidence of cerebral herniation in the DC group (73% vs 0%, P = .005).
- DC group had longer hospital stays (41 vs 17 days, P = .0005); all DC patients survived, with early DC linked to better outcomes.
Conclusions:
- Early DC in pediatric sTBI is associated with increased survival.
- Timely decompressive craniectomy improves functional outcomes in pediatric severe traumatic brain injury patients.
Objective:
There is no consensus on the use of decompressive craniectomy (DC) to manage severe traumatic brain injury (sTBI). We evaluated the profile of pediatric patients admitted with sTBI and assessed functional outcomes, 6 months posttrauma, in patients who had a DC and in those who had not, and the functional outcomes of early versus late DCs.
Patients And Methods:
This case-control observational study evaluated pediatric patients admitted for sTBI in Puerto Rico (June 2016-October 2018); we included patients admitted within 24 hours of injury and had a Glasgow Coma Scale (GCS) of 8 or lower. 6-month post trauma outcomes were measured with the Glasgow Outcome Scale Extended Pediatric (GOS-E Peds).
Results:
20 patients were included; 15 underwent a DC and 5 comprised the control group. We found no differences in terms of sex, age, GCS score, Pediatric Risk of Mortality score, or Pediatric Trauma Score. However, in the DC group, a higher percentage of patients presented significant cerebral herniation in the initial computed tomography scan (CT) (DC: 73%; control: 0%; P = .005). No differences were found regarding intracranial pressure (ICP), cerebral perfusion pressure, mean arterial pressure, PaCO2, or temperature. Patients in the DC group had longer hospital stay (DC: 41; control: 17 days; P = .0005). All patients with DC survived, with an early procedure being associated with favorable outcomes.
Conclusion:
As determined 6 months post-trauma, this study showed that early DC increased survival and improved functionality.
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