Prognostic Predictors of Decompressive Craniectomy in Traumatic Brain Injury: A Clinical Experience of 128 Cases

Abstract

Objectives The objective of this study was to analyze different parameters such as clinicoradiological presentation, surgical outcome, and factors associated with prognosis of traumatic brain injury patients undergoing decompressive craniectomy (DC).

Materials and Methods This observational study was done on all the cases of DC undertaken in our hospital during July 2013 to June 2015. In all cases, the age, sex, mode of injury, severity of injury, associated injuries, indications, computed tomography (CT) finding, complications, and outcomes in the form of morbidity and mortality were analyzed.

Results Out of all head injury patients admitted, only 3.036% underwent DC. The most common age group affected was 19 to 40 years (n = 49; 43.75%; p-value < 0.001). Male to female ratio was 3.8:1; 66.07% presented with Glasgow coma scale (GCS) score ≤ 8. Pupillary abnormality was found in 34 (30.35%) patients. ASDH was the most common (n = 97; 86.66%) CT finding. Road traffic accident (RTA) was the most common mode of injury found in 69.64% of patients. Aspiration pneumonia and ventilator-associated pneumonia were the most common nonneurosurgical complication found in 14.28% of patients. Total number of deaths was 30 (26.78%). On analysis, patients with low admission GCS, pupillary dilatation, trauma due to RTA, associated injury, and aspiration pneumonia show high mortality (p < 0.05). Eighty-two (73.21%) patients survived and 54 (48.21%) patients discharged with good neurological condition.

Conclusion DC yields good results in traumatic brain injury. GCS score < 8, associated subarachnoid hemorrhage, midline shift, intraoperative brain bulge, associated chest injury and long bone fracture, cerebral infraction, old age > 40 years, male sex, alcoholics, pupillary dilation, and aspiration pneumonia are the independent factors for increased mortality and disability.

Keywords

decompressive craniectomy - good outcome - severe head injury - prognostic factors - clinicoradiological features

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