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Published on: August 14, 2019
Novel association of the Rotterdam computed tomography score with decompressive craniectomy in acute traumatic
Tianqi Xiao1, Asha Sethuraman2, Mohamed E El-Abtah1
1Case Western Reserve University School of Medicine, Cleveland, OH, USA.
Background And Objectives:
The decision to perform a craniotomy (CO) versus decompressive craniectomy (DC) for acute subdural hematomas (aSDH) after traumatic brain injury (TBI) remains challenging. Rotterdam Computed Tomography (RCT) scoring has been shown to correlate with outcome measures in TBI. This study examines the association between RCT scoring and the decision to pursue CO or DC in TBI patients with aSDH.
Methods:
A single-center retrospective review was conducted on adult patients who presented with aSDH and received either a CO or DC between 2018 and 2021. Baseline demographics and clinical presentation characteristics were collected. Chi-square, Wilcoxon sum rank test, and t-test were used to compare means. Multivariate stepwise logistic regression models were developed for a predictive model and the receiver operating characteristic curve was analyzed.
Results:
A total of 126 patients were identified. Patients who underwent DC compared to CO had significantly younger age, higher Injury Severity Scores (ISS), lower Glasgow Come Scale (GCS), and higher RCT scores. After multivariate stepwise logistic regression, GCS and RCT scores greater than or equal to 3 (RCT3) were independently associated with DC in aSDH. Patients with RCT3 were three times more likely to undergo DC (odds ratio 3.22; 95% confidence interval: 1.19-8.67).
Conclusion:
A RCT score of greater than or equal to 3, a younger age, and lower GCS were associated with increased odds of undergoing DC compared to CO for traumatic aSDHs. RCT scores are associated with DC versus CO in patients with aSDH.
