Decompressive craniectomy for traumatic brain injury: outcomes and their determinants

Background Decompressive craniectomy (DC) is a management option to control raised intracranial pressure (ICP) in traumatic brain injury (TBI) with inconsistent evidence for its outcomes and their determinants. Objectives The aim of this study was to assess the outcomes and determinants of outcomes of DC done in National Hospital of Sri Lanka (NHSL) at one year and three years of follow-up. Materials and methods Patients who underwent DC for TBI within 6 months period from 01/02/2016 to 31/07/ 2016 at the Neurotrauma Centre, NHSL were included in the study. Data were retrieved from medical records. Outcomes were evaluated by interviewing patients/relatives over the telephone using standard questionnaire for extended Glasgow Outcome scale (GOS-E). Results Inclusion and exclusion criteria matched 118 patients were selected and 89 (75.42%) contactable patients were included in the analysis. Majority (86.4%) were males and median age was 45 years. There were 56 primary DCs and 33 secondary DCs. Favorable outcomes (GOS-E 5-8) were seen in 20.2% and in 24.7% at the end of one year and three years respectively. Younger age, good pupillary reaction and higher GCS on admission were associated with statistically significant favorable outcomes (P<0.05). Pupillary symmetry, timing of DC (primary or secondary), time elapsed from time of injury to performing primary DC, type of DC, whether CT shows an isolated lesion or multiple lesions, submission to tracheostomy, having medical comorbidities and postoperative infections were not predictive of the outcome. Conclusion Favorable functional outcomes following DC for TBI is limited to 20-25%. Younger age, good pupillary reaction and higher GCS are predictors of favorable functional outcomes.