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Controlled Cortical Impact Model for Traumatic Brain Injury
Published on: August 5, 2014
Long-term functional outcomes following pediatric decompressive craniectomy for traumatic brain injury
Julian Michael Burwell1, Brandon Gonzalez1, Blandine Ehinnou1
1Department of Medical Education, Geisinger Commonwealth School of Medicine, Scranton, PA, USA.
Insights
Pediatric head trauma patients undergoing decompressive craniectomy (DC) showed similar functional outcomes to those managed non-operatively (NOM) for up to four years, despite worse initial injuries. Long-term outcomes varied, with neurological sequelae more common in DC survivors.
Area of Science:
- Neuroscience
- Trauma Surgery
- Pediatric Critical Care
Background:
- Severe head trauma in children presents complex management challenges.
- Decompressive craniectomy (DC) and non-operative management (NOM) are treatment options with varying outcomes.
- Understanding long-term functional recovery is crucial for pediatric head trauma patients.
Purpose of the Study:
- To compare 5-year functional outcomes between pediatric head trauma patients treated with DC versus NOM.
- To evaluate the impact of initial injury severity on outcomes in these cohorts.
Main Methods:
- Retrospective case-control study (2017-2024) of 195 pediatric trauma admissions (ages 2-18) with moderate to severe head trauma (GCS ≤ 12).
- Two matched cohorts (DC vs. NOM) were created based on age, sex, and injury severity.
- Functional outcomes assessed annually for five years using the Glasgow Outcome Scale Extended (GOSE) and the للك Schmid Clinical Impact Scale (KOSCHI).
Main Results:
- Fifty-two patients (26 matched pairs) were analyzed; the DC group had significantly worse intracranial pathology and higher mortality.
- Functional outcomes (GOSE, KOSCHI) were comparable between DC and NOM groups through year four (p=0.068).
- At five years, the NOM group showed a trend towards better outcomes (p=0.046), limited by small sample size; no DC survivors declined functionally.
- Neurological sequelae were more frequent in the DC group, while psychiatric complaints were more common in the NOM group.
Conclusions:
- Pediatric head trauma patients undergoing DC achieved comparable functional outcomes to NOM patients up to four years post-injury, despite more severe initial intracranial pathology.
- Long-term functional recovery trajectories may differ, with potential for neurological sequelae in DC patients and psychiatric complaints in NOM patients.
- Further research with larger sample sizes is needed to clarify five-year outcomes and long-term differences between DC and NOM in pediatric head trauma.
Purpose:
Determine whether there is a difference in 5-year functional outcomes between pediatric head trauma cases who received DC vs. non-operative management (NOM).
Methods:
A seven-year (2017-2024) retrospective, case-control study of 195 pediatric trauma admissions (ages 2-18) at two Level-1 Trauma Centers. Subjects with primary head trauma and GCS ≤ 12 were included. Cases were divided into two matched cohorts based on age, sex, and injury severity. The DC group was characterized by surgical indication, and non-operative management (NOM) interventions were recorded by tier per Brain Trauma Foundation guidelines. Outcomes were assessed annually over five years using GOSE and KOSCHI. Statistical tests included χ2, t-test, and CMH test for outcome shifts.
Results:
Twenty-six matched pairs (n = 52) were included in the final analysis. The DC group had markedly worse intracranial pathology, including midline shift (38.46% DC vs 0% NOM, p = .001) and cisternal compression (65.38% DC vs 7.69% NOM, p < .001), along with higher hospital mortality (15.38% DC vs 0% NOM). CMH shift testing of GOSE and KOSCHI demonstrated comparable outcomes between cohorts from years one through four (p = .068). At five years, the NOM group exhibited a trend toward better outcomes (p = .046), although interpretation was limited by a small sample size at this time point (n = 5), with the remainder lost to follow-up. Notably, no DC survivors with available follow-up data demonstrated functional decline over time. On follow-up, neurological symptoms sequelae were more common in the DC group, while psychiatric complaints were more frequently reported in the NOM group.
Conclusion:
Despite significantly worse intracranial pathology, DC patients who remained in follow-up achieved comparable functional outcomes to NOM patients through four years.
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