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Decompressive Craniectomy and Outcomes in Severe Traumatic Brain Injury in Children and Adolescent Patients
Nasim Ahmed1,2, Larissa Russo3, Yen-Hong Kuo4,5
1Department of Surgery, Hackensack Meridian School of Medicine, Nutley , New Jersey , USA.
Insights
Decompressive craniectomy did not significantly improve long-term neurological outcomes for children with severe traumatic brain injury (TBI). This study found no difference in Glasgow Outcome Scale-Extended scores at 6 months between surgical and medical management groups.
Area of Science:
- Pediatric neurosurgery
- Trauma critical care
- Neurological outcomes research
Background:
- Decompressive craniectomy is used to manage increased intracranial pressure (ICP) in severe traumatic brain injury (TBI).
- Conflicting evidence exists on the efficacy of decompressive craniectomy in pediatric TBI patients.
- A need for further investigation into long-term outcomes is apparent.
Purpose of the Study:
- To evaluate the long-term neurological outcomes of decompressive craniectomy in pediatric patients with severe TBI.
- To compare outcomes between patients treated with decompressive craniectomy versus continued medical management.
- To address the existing gap in evidence regarding this surgical intervention in children.
Main Methods:
- Utilized data from the Approaches and Decisions in Acute Pediatric TBI Trial.
- Included pediatric patients (<18 years) with severe TBI (GCS ≤8) and sustained elevated ICP (≥20 mm Hg for 2 hours).
- Employed propensity score matching to compare decompressive craniectomy with medical management, assessing the 6-month Glasgow Outcome Scale-Extended score.
Main Results:
- Of 465 eligible patients, 62 underwent decompressive craniectomy and 403 received medical management.
- Pair-matched analysis revealed no significant difference in 6-month Glasgow Outcome Scale-Extended scores between the groups (50.0% vs 58.8%, P = .661).
- Detailed functional outcome categories (recovery, disability, vegetative state, death) also showed no statistically significant differences between treatment groups.
Conclusions:
- Decompressive craniectomy in severe pediatric TBI does not lead to significantly different neurological function at 6 months compared to medical management.
- The findings suggest that surgical decompression may not offer a distinct advantage in long-term recovery for this patient population.
- Further research may be warranted to explore specific subgroups or alternative treatment strategies.
Background And Objectives:
Decompressive craniectomy has been used to reduce the increased intracranial pressure (ICP) in severe traumatic brain injury (TBI). However, recent retrospective studies showed conflicting results regarding the benefit of decompressive craniectomy in children. Owing to the gap in information, we designed a study to examine the long-term outcomes of decompressive craniectomy.
Methods:
This study was performed from data obtained from the Approaches and Decisions in Acute Pediatric TBI Trial. Included in the study were all patients younger than 18 years with severe TBI (Glasgow Coma Scale Score ≤8) that had hourly ICP measurements ≥20 mm Hg for 2 consecutive hours during the first 7 intensive care unit days. Patients were divided into groups based on whether they underwent decompressive craniectomy after 2 consecutive hours of ICP ≥20 mm Hg or continued to receive medical management. The data for this study were obtained from the Federal Interagency Traumatic Brain Injury Research Informatics System. Propensity score matching was used to compare decompressive craniectomy with medical management. The primary outcome was 6-month Glasgow Outcome Scale-Extended score.
Results:
Of the 465 patients who qualified for the study, 403 (86.7%) underwent medical management and 62 (13.3%) underwent decompressive craniectomy. Pair-matched analysis did not show any significant difference between the 2 groups in 6-month Glasgow Outcome Scale-Extended score (favorable, 50.0% vs 58.8%, P = .661) and in upper good recovery (11.4% vs 20.5%), lower good recovery (2.3% vs 11.4%), upper moderate disability (9.1% vs 13.6%), lower moderate disability (9.1% vs 0.0%), upper severe disability (15.9% vs 11.4%), lower severe disability (27.3% vs 15.9%), vegetative state (4.5% vs 0.0%), and death (20.5% vs 27.3%).
Conclusion:
There was no significant difference in neurological function at 6 months between patients who did and did not undergo decompressive craniectomy after severe TBI.
