Outcome of children with severe traumatic brain injury who are treated with decompressive craniectomy
| العنوان: | Outcome of children with severe traumatic brain injury who are treated with decompressive craniectomy |
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| المؤلفون: | Maroun J. Mhanna, Rajiv R. Shah, Margaret A. Verrees, Dennis M. Super, Wael Ei Mallah |
| المصدر: | Journal of Neurosurgery: Pediatrics. 16:508-514 |
| بيانات النشر: | Journal of Neurosurgery Publishing Group (JNSPG), 2015. |
| سنة النشر: | 2015 |
| مصطلحات موضوعية: | Pediatrics, medicine.medical_specialty, Traumatic brain injury, business.industry, medicine.medical_treatment, Glasgow Outcome Scale, Glasgow Coma Scale, Poison control, General Medicine, medicine.disease, Cerebral edema, Interquartile range, Anesthesia, medicine, Decompressive craniectomy, business, Intracranial pressure |
| الوصف: | OBJECT Decompressive craniectomy (DC) for the management of severe traumatic brain injury (TBI) is controversial. The authors sought to determine if DC improves the outcome of children with severe TBI. METHODS In a retrospective, case-control study, medical records of all patients admitted to the pediatric ICU between May 1998 and May 2008 with severe TBI and treated with DC were identified and matched to patients who were treated medically without DC. Medical records were reviewed for patients’ demographic data and baseline characteristics. RESULTS During the study period, 17 patients with severe TBI treated with DC at a median of 2 hours (interquartile range [IQR] 1–14 hours) after admission were identified and matched to 17 contemporary controls. On admission, there were no differences between DC and control patients regarding age (10.2 ± 5.9 years vs 12.4 ± 5.4 years, respectively [mean ± SD]), sex, weight, Glasgow Coma Scale score (median 5 [IQR 3–7] vs 4 [IQR 3–6], respectively; p = 0.14), or the highest intracranial pressure (median 42 [IQR 22–54] vs 30 [IQR 21–36], respectively; p = 0.77). However, CT findings were significant for a higher rate of herniation and cerebral edema among patients with DC versus controls (7/17 vs 2/17, respectively, had herniation [p = 0.05] and 14/17 vs 6/17, respectively, had cerebral edema [p = 0.006]). Overall there were no significant differences in survival between patients with DC and controls (71% [12/17] vs 82% [14/17], respectively; p = 0.34). However, among survivors, at 4 years (IQR 1–6 years) after the TBI, 42% (5/12) of the DC patients had mild disability or a Glasgow Outcome Scale score of 5 vs none (0/14) of the controls (p = 0.012). CONCLUSIONS In this retrospective, small case-control study, the authors have shown that early DC in pediatric patients with severe TBI improves outcome in survivors. Future prospective randomized controlled studies are needed to confirm these findings. |
| تدمد: | 1933-0715 1933-0707 |
| URL الوصول: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::158f5e7b0da5c6d32aacd24a45460ccf https://doi.org/10.3171/2014.10.peds14117 |
| حقوق: | OPEN |
| رقم الأكسشن: | edsair.doi.dedup.....158f5e7b0da5c6d32aacd24a45460ccf |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 19330715 19330707 |
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