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Published on: October 17, 2017
An Analysis of Emergency Surgical Outcomes for Pediatric Traumatic Brain Injury: A Ten-Year Single-Institute
Cheng-Yu Tsai1,2,3,4, Keng-Liang Kuo1,3, Chieh-Hsin Wu1,3
1Division of Neurosurgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan.
Insights
Pediatric traumatic brain injury (pTBI) surgical outcomes show decompressive craniectomy is effective. Early cranioplasty after surgery may reduce post-traumatic hydrocephalus.
Area of Science:
- Neurosurgery
- Pediatric Traumatology
- Public Health
Background:
- Pediatric traumatic brain injury (pTBI) is a significant public health concern.
- Effective injury prevention programs exist, yet pTBI remains prevalent.
- Understanding surgical outcomes is crucial for managing pTBI.
Purpose of the Study:
- To analyze emergency surgical outcomes for pediatric traumatic brain injury (pTBI).
- To provide real-world clinical data from a ten-year retrospective study.
- To categorize pTBI etiologies and inform disease-oriented treatment.
Main Methods:
- Retrospective analysis of 150 pediatric TBI cases undergoing emergency surgery (2010-2019).
- Inclusion of patients diagnosed with TBI and requiring surgical intervention.
- Data collection on radiological findings, surgical procedures, and patient outcomes.
Main Results:
- Common radiological findings include brain edema, acute subdural hematoma, and epidural hematoma.
- Decompressive craniectomy (DC) is a primary surgical intervention.
- Poor outcomes associated with brain edema, acute/chronic subdural hematomas; good outcomes with epidural hematoma, skull fracture, subarachnoid hemorrhage.
- Glasgow Coma Scale (GCS) scores improved post-surgery.
- Time to cranioplasty correlated with post-traumatic hydrocephalus (PTH) development.
Conclusions:
- Decompressive craniectomy (DC) remains a key surgical treatment for pTBI.
- Early cranioplasty may reduce the incidence of post-traumatic hydrocephalus (PTH).
- Categorizing pTBI by etiology aids in targeted treatment strategies.
Abstract:
Background and Objectives: Pediatric traumatic brain injury (pTBI) remains a major pediatric public health problem, despite well-developed injury prevention programs. The purpose of this study is to analyze the emergency surgical outcomes of pTBI in a single institute ten-year retrospective study to offer a real-world clinical result. Materials and Methods: Our institute presented a clinical retrospective, single-institute research study of 150 pediatric TBI cases that were diagnosed and underwent emergency surgical treatment from 2010 to 2019. Results: The incidence of radiological findings is detailed as follows: brain edema (30%, 45/150), followed by acute subdural hematoma (27.3%, 41/150), epidural hematoma (21.3%, 32/150), chronic subdural hemorrhage (10%, 15/150), skull fracture (6.7%, 10/150), and traumatic subarachnoid hemorrhage (4.7%, 7/150). Surgical intervention data revealed that decompressive craniectomy was still the main effective surgical method. The results showed longer hospital stays and higher morbidity rates in the brain edema, acute subdural hematoma, and chronic subdural hemorrhage groups, which were viewed as poor surgical outcome groups. Epidural hematoma, skull fracture and traumatic subarachnoid hemorrhage were categorized into good surgical outcome groups. Notably, the data revealed gross improvement in Glasgow Coma Scale/Score (GCS) evolution after surgical interventions, and the time to cranioplasty was a significant factor in the development of post-traumatic hydrocephalus (PTH). Conclusions: Our study provided real-world data for the distribution of etiology in pTBI and also categorized it into six groups, indicating disease-orientated treatment. In addition, our data supported that decompressive craniectomy (DC) remains a mainstay surgical treatment in pTBI and early cranioplasty could decrease the incidence of PTH.
