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  • Decraene, BrechtUniversity Hospitals Leuven, Leuven, Belgium (författare)

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

  • Artikel/kapitelEngelska2023

Förlag, utgivningsår, omfång ...

  • Elsevier,2023
  • printrdacarrier

Nummerbeteckningar

  • LIBRIS-ID:oai:DiVA.org:uu-519805
  • https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-519805URI
  • https://doi.org/10.1016/j.injury.2023.110911DOI

Kompletterande språkuppgifter

  • Språk:engelska
  • Sammanfattning på:engelska

Ingår i deldatabas

Klassifikation

  • Ämneskategori:ref swepub-contenttype
  • Ämneskategori:art swepub-publicationtype

Anmärkningar

  • 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 och genrebeteckningar

Biuppslag (personer, institutioner, konferenser, titlar ...)

  • Klein, Samuel P.University Hospitals Leuven, Leuven, Belgium (författare)
  • Piper, IanSouthern General Hospital, Glasgow, United Kingdom (författare)
  • Gregson, BarbaraNewcastle University, Newcastle, United Kingdom (författare)
  • Enblad, PerUppsala universitet,Neurokirurgi(Swepub:uu)perenbla (författare)
  • Ragauskas, ArminasKaunas University of Technology, Kaunas, Lithuania (författare)
  • Citerio, GiuseppeUniversity of Milano-Bicocca, Milano, Italy (författare)
  • Chambers, IainJames Cook University Hospital, Middlesbrough, United Kingdom (författare)
  • Neumann, Jan-OliverUniversitätsklinikum Heidelberg, Heidelberg, Germany (författare)
  • Sahuquillo, JuanUniversity Hospital Vall d ́Hebron, Barcelona, Spain (författare)
  • Kiening, KarlUniversitätsklinikum Heidelberg, Heidelberg, Germany (författare)
  • Moss, LauraSouthern General Hospital, Glasgow, United Kingdom (författare)
  • Nilsson, PelleUppsala universitet,Neurokirurgi(Swepub:uu)pellnils (författare)
  • Donald, RobStats Research, Scotland, United Kingdom (författare)
  • Howells, TimUppsala universitet,Neurokirurgi(Swepub:uu)timho266 (författare)
  • Lo, MillyUniversity of Edinburgh, Edinburgh, United Kingdom (författare)
  • Depreitere, BartUniversity Hospitals Leuven, Leuven, Belgium (författare)
  • University Hospitals Leuven, Leuven, BelgiumSouthern General Hospital, Glasgow, United Kingdom (creator_code:org_t)

Sammanhörande titlar

  • Ingår i:Injury: Elsevier54:90020-13831879-0267

Internetlänk

Hitta via bibliotek

  • Injury (Sök värdpublikationen i LIBRIS)

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