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Early versus Late Decompressive Craniectomy in Pediatrics with Traumatic Brain Injuries: A Retrospective Study
Amer Jaradat1, Mohammed M Al Barbarawi1, Mohammad Jamous1
1Department of Neurosurgery, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan.
Insights
Decompressive craniectomy (DC) is vital for severe traumatic brain injury (TBI) in children to manage intracranial pressure. This study found no significant outcome difference between early and late DC, but pupillary abnormalities indicated prognosis.
Area of Science:
- Pediatric Neurosurgery
- Trauma Surgery
- Critical Care Medicine
Background:
- Severe traumatic brain injury (TBI) is a major cause of death and disability in children globally.
- Effective management of TBI involves controlling intracranial pressure (ICP).
- Decompressive craniectomy (DC) is a critical intervention for refractory ICP in severe TBI.
Purpose of the Study:
- To investigate the effectiveness of early decompressive craniectomy (DC) in pediatric severe TBI.
- To evaluate the impact of surgical timing on patient outcomes.
- To identify prognostic factors in pediatric severe TBI patients undergoing DC.
Main Methods:
- Retrospective analysis of pediatric patients (<16 years) with severe TBI.
- Inclusion criteria: patients undergoing DC within 24 hours of injury.
- Data collected on patient demographics, outcomes, complications, and surgical timing.
Main Results:
- A cohort of 45 pediatric patients with severe TBI undergoing DC was analyzed.
- Favorable outcomes (Glasgow Outcome Score 4-5) were observed in 67% of cases.
- Pupillary abnormalities were significantly linked to prognosis (P=0.004), while surgical timing was not (P=0.661).
Conclusions:
- Decompressive craniectomy (DC) remains essential for managing pediatric severe TBI and ICP.
- This study found no significant difference in outcomes between early and late DC.
- Pupillary abnormalities are a critical prognostic indicator; further research on optimal surgical timing is warranted.
Background:
Severe traumatic brain injury (TBI) is a leading cause of mortality and disability in pediatric patients, especially in low- and middle-income countries. TBI significantly impacts child development and incurs substantial health care costs. Management of severe TBI includes evidence-based protocols to prevent and treat increased intracranial pressure (ICP), with decompressive craniectomy (DC) as a rescue measure. This study investigates the role of early DC in improving outcomes for children with severe TBI.
Methods:
A retrospective study was conducted from January 2003 to January 2023 at King Abdullah University Hospital, the main tertiary hospital in North Jordan. This study evaluated pediatric patients (under 16 years old) admitted with severe TBI who underwent early DC (within 24 hours).
Results:
This study of 45 pediatric patients undergoing DC for severe TBI found a male predominance (75.6%) and a mean age of 4.3 years. Favorable outcomes (Glasgow Outcome Score 4-5) were achieved in 67% of cases. Pupillary abnormalities were significantly associated with prognosis (P = 0.004), but surgical timing (<6 vs. >6 hours) was not (P = 0.661). The in-hospital mortality rate was 24%, with complications in 35.6% of patients. ICP monitoring was performed in 26.7% of patients.
Conclusions:
DC remains a crucial intervention for pediatric patients with severe TBI, primarily to control ICP. Our study found no significant difference in outcomes between early and late DC, aligning with prior research. However, pupillary abnormalities emerged as a key prognostic factor. Our findings highlight the need for further prospective multicenter studies to refine surgical timing for optimal outcomes.
