Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine (Nov 2022)

Characteristics and therapeutic profile of TBI patients who underwent bilateral decompressive craniectomy: experience with 151 cases

  • Jian-Lan Zhao,
  • Jie Song,
  • Qiang Yuan,
  • Yi-Feng Bao,
  • Yi-Rui Sun,
  • Zhi-Qi Li,
  • Cai-Hua Xi,
  • Hai-Jun Yao,
  • Mei-Hua Wang,
  • Gang Wu,
  • Zhuo-Ying Du,
  • Jin Hu,
  • Jian Yu

DOI
https://doi.org/10.1186/s13049-022-01046-w
Journal volume & issue
Vol. 30, no. 1
pp. 1 – 10

Abstract

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Abstract Background Decompressive craniectomy (DC) and intracranial pressure (ICP) monitoring are common approaches to reduce the death rate of Traumatic brain injury (TBI) patients, but the outcomes of these patients are unfavorable, particularly those who receive bilateral DC. The authors discuss their experience using ICP and other potential methods to improve the outcomes of TBI patients who receive bilateral DC. Methods Data from TBI patients receiving bilateral DC from Jan. 2008 to Jan. 2022 were collected via a retrospective chart review. Included patients who received unplanned contralateral DC after initial surgery were identified as unplanned secondary surgery (USS) patients. Patients’ demographics and baseline medical status; pre-, intra-, and postoperative events; and follow-up visit outcome data were analyzed. Results A total of 151 TBI patients were included. Patients who underwent USS experienced more severe outcomes as assessed using the 3-month modified Rankin Scale score (P = 0.024). In bilateral DC TBI patients, USS were associated with worsen outcomes, moreover, ICP monitoring was able to lower their death rate and was associated with a lower USS incidence. In USS patients, ICP monitoring was not associated with improved outcomes but was able to lower their mortality rate (2/19, 10.5%, vs. 10/25, 40.0%; P = 0.042). Conclusion The avoidance of USS may be associated with improved outcomes of TBI patients who underwent bilateral DC. ICP monitoring was a potential approach to lower USS rate in TBI patients, but its specific benefits were uncertain.

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