Interdisciplinary Neurosurgery (Mar 2022)

Decompressive craniectomy after traumatic brain injury: An observational study of 147 patients admitted in a Tunisian ICU

  • Rania Ammar,
  • Hedi Chelly,
  • Fatma Kolsi,
  • Mariem Smaoui,
  • Chokri Ben Hamida,
  • Mabrouk Bahloul,
  • Zaher Boudawara,
  • Mounir Bouaziz

Journal volume & issue
Vol. 27
p. 101421

Abstract

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Objective: To analyze clinical, epidemiological, radiological characteristics and outcome of patients undergoing decompressive craniectomy (DC) after traumatic brain injury (TBI) and to identity predictive factors associated with poor prognosis. Methods: Demographic, clinical, and radiologic data from a retrospective study on unilateral or bilateral DC following TBI, admitted to the Intensive Care Unit (ICU) of a university hospital (Sfax-Tunisia), were collected during a 9-year period. Results: We included 147 patients. Ninety-nine patients (67.7%) were younger than 45 years. GCS ≤ 8 was found in 100 patients (68%). Primary DC was done for 104 patients (70.74%) and secondary DC was done for 43 patients (29.25%). Surgery was done within the first 6 h for 94 patients (63.9%). A mortality rate was at 42.2%. Independent factors associated with mortality were age > 65 years (p = 0.001;OR8.9;CI95% [1.90–42.02]),GCS ≤ 8 (p = 0.001;OR3.8;CI95%[1.69–8.54]),SOFA score > 5 (p = 0.01;OR2.2; CI95%[1.13–4.32]), persistence anisocoria or mydriasis after surgery (p 45 mmHg (p = 0.002;OR4.2; CI95%[1.62–10.9]), disseminated intravascular coagulation (p = 0.003;OR4.3;CI 95% [1.57–11.96]) and use of corticosteroids (p = 0.034; OR2.04;CI95%[1.05–3.97]). Independent factors associated with poor outcome at discharge were GCS ≤ 8 (p = 0.029; OR 2.72; CI95% [1.09–6.78]), hydrocephalus (p = 0.017; OR4.13; CI95% [1.21–14.1]) and hyponatremia < 135 mmol/l (p = 0.009; OR6.77; CI95% [1.38–33.1]). Independent factors associated with poor outcome at 6 months were GCS ≤ 8 (p = 0.014; OR 3.93; CI 95% [1.27–12.1]), systolic arterial pressure < 90 mmHg at admission (p = 0.029; OR 3.54; CI 95% [2.48–5.05]) and diffuse axonal injury (p = 0.009; OR 3.89; CI 95% [1.35–11.2]). Conclusion: DC can be life-saving for patients with TBI with decrease of mortality. The control of secondary systemic insults may lead to good prognosis.

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