Decompressive craniectomy as a second/third-tier intervention in traumatic brain injury: A multicenter observational study

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Decompressive craniectomy as a second/third-tier intervention in traumatic brain injury : A multicenter observational study

Decraene, Brecht (författare): University Hospitals Leuven, Leuven, Belgium

Klein, Samuel P. (författare): University Hospitals Leuven, Leuven, Belgium

Piper, Ian (författare): Southern General Hospital, Glasgow, United Kingdom

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Gregson, Barbara (författare): Newcastle University, Newcastle, United Kingdom

Enblad, Per (författare): Uppsala universitet,Neurokirurgi

Ragauskas, Arminas (författare): Kaunas University of Technology, Kaunas, Lithuania

Citerio, Giuseppe (författare): University of Milano-Bicocca, Milano, Italy

Chambers, Iain (författare): James Cook University Hospital, Middlesbrough, United Kingdom

Neumann, Jan-Oliver (författare): Universitätsklinikum Heidelberg, Heidelberg, Germany

Sahuquillo, Juan (författare): University Hospital Vall d ́Hebron, Barcelona, Spain

Kiening, Karl (författare): Universitätsklinikum Heidelberg, Heidelberg, Germany

Moss, Laura (författare): Southern General Hospital, Glasgow, United Kingdom

Nilsson, Pelle (författare): Uppsala universitet,Neurokirurgi

Donald, Rob (författare): Stats Research, Scotland, United Kingdom

Howells, Tim (författare): Uppsala universitet,Neurokirurgi

Lo, Milly (författare): University of Edinburgh, Edinburgh, United Kingdom

Depreitere, Bart (författare): University Hospitals Leuven, Leuven, Belgium

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Elsevier, 2023
2023
Engelska.
Ingår i: Injury. - : Elsevier. - 0020-1383 .- 1879-0267. ; 54:9

Relaterad länk:: https://urn.kb.se/re...; visa fler...; https://doi.org/10.1...; visa färre...

Tidskriftsartikel (refereegranskat)

Abstract Ämnesord

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Objectives: RESCUEicp studied decompressive craniectomy (DC) applied as third-tier option in severe traumatic brain injury (TBI) patients in a randomized controlled setting and demonstrated a decrease in mortality with similar rates of favorable outcome in the DC group compared to the medical management group. In many centers, DC is being used in combination with other second/third-tier therapies. The aim of the present study is to investigate outcomes from DC in a prospective non-RCT context.Methods: This is a prospective observational study of 2 patient cohorts: one from the University Hospitals Leuven (2008-2016) and one from the Brain-IT study, a European multicenter database (2003-2005). In thirty-seven patients with refractory elevated intracranial pressure who underwent DC as a second/third-tier intervention, patient, injury and management variables including physiological monitoring data and administration of thio-pental were analysed, as we l l as Extended Glasgow Outcome score (GOSE) at 6 months.Results: In the current cohorts, patients were older than in the surgical RESCUEicp cohort (mean 39.6 vs. 32.3; p < 0.001), had higher Glasgow Motor Score on admission (GMS < 3 in 24.3% vs. 53.0%; p = 0.003) and 37.8% received thiopental (vs. 9.4%; p < 0.001). Other variables were not significantly different. GOSE distribution was: death 24.3%; vegetative 2.7%; lower severe disability 10.8%; upper severe disability 13.5%; lower moderate disability 5.4%; upper moderate disability 2.7%, lower good recovery 35.1%; and upper good recover y 5.4%. The outcome was unfavorable in 51.4% and favorable in 48.6%, as opposed to 72.6% and 27.4% respectively in RESCUEicp (p = 0.02).Conclusion: Outcomes in DC patients from two prospective cohorts reflecting everyday practice were better than in RESCUEicp surgical patients. Mortality was similar, but fewer patients remained vegetative or severely disabled and more patients had a good recovery. Although patients were older and injury severity was lower, a potential partial explanation may be in the pragmatic use of DC in combination with other second/third-tier therapies in real-life cohorts. The findings underscore that DC maintains an important role in managing se-vere TBI.

Ämnesord

MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Neurologi (hsv//swe)
MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Neurology (hsv//eng)
MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kirurgi (hsv//swe)
MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Surgery (hsv//eng)
MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Anestesi och intensivvård (hsv//swe)
MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Anesthesiology and Intensive Care (hsv//eng)

Nyckelord

Traumatic brain injury
Decompressive craniectomy
Neurointensive care
Intracranial pressure
Cerebral autoregulation
TBI

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Av författaren/redakt...: Decraene, Brecht; Klein, Samuel P.; Piper, Ian; Gregson, Barbara; Enblad, Per; Ragauskas, Armin ...; visa fler...; Citerio, Giusepp ...; Chambers, Iain; Neumann, Jan-Oli ...; Sahuquillo, Juan; Kiening, Karl; Moss, Laura; Nilsson, Pelle; Donald, Rob; Howells, Tim; Lo, Milly; Depreitere, Bart; visa färre...

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MEDICIN OCH HÄLSOVETENSKAP: MEDICIN OCH HÄLS ...; och Klinisk medicin; och Neurologi

MEDICIN OCH HÄLSOVETENSKAP: MEDICIN OCH HÄLS ...; och Klinisk medicin; och Kirurgi

MEDICIN OCH HÄLSOVETENSKAP: MEDICIN OCH HÄLS ...; och Klinisk medicin; och Anestesi och int ...

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