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LIBRIS Formathandbok  (Information om MARC21)
FältnamnIndikatorerMetadata
00005556naa a2200589 4500
001oai:DiVA.org:uu-519805
003SwePub
008240110s2023 | |||||||||||000 ||eng|
0247 a https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-5198052 URI
0247 a https://doi.org/10.1016/j.injury.2023.1109112 DOI
040 a (SwePub)uu
041 a engb eng
042 9 SwePub
072 7a ref2 swepub-contenttype
072 7a art2 swepub-publicationtype
1001 a Decraene, Brechtu University Hospitals Leuven, Leuven, Belgium4 aut
2451 0a Decompressive craniectomy as a second/third-tier intervention in traumatic brain injury :b A multicenter observational study
264 1b Elsevier,c 2023
338 a print2 rdacarrier
520 a 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.
650 7a MEDICIN OCH HÄLSOVETENSKAPx Klinisk medicinx Neurologi0 (SwePub)302072 hsv//swe
650 7a MEDICAL AND HEALTH SCIENCESx Clinical Medicinex Neurology0 (SwePub)302072 hsv//eng
650 7a MEDICIN OCH HÄLSOVETENSKAPx Klinisk medicinx Kirurgi0 (SwePub)302122 hsv//swe
650 7a MEDICAL AND HEALTH SCIENCESx Clinical Medicinex Surgery0 (SwePub)302122 hsv//eng
650 7a MEDICIN OCH HÄLSOVETENSKAPx Klinisk medicinx Anestesi och intensivvård0 (SwePub)302012 hsv//swe
650 7a MEDICAL AND HEALTH SCIENCESx Clinical Medicinex Anesthesiology and Intensive Care0 (SwePub)302012 hsv//eng
653 a Traumatic brain injury
653 a Decompressive craniectomy
653 a Neurointensive care
653 a Intracranial pressure
653 a Cerebral autoregulation
653 a TBI
7001 a Klein, Samuel P.u University Hospitals Leuven, Leuven, Belgium4 aut
7001 a Piper, Ianu Southern General Hospital, Glasgow, United Kingdom4 aut
7001 a Gregson, Barbarau Newcastle University, Newcastle, United Kingdom4 aut
7001 a Enblad, Peru Uppsala universitet,Neurokirurgi4 aut0 (Swepub:uu)perenbla
7001 a Ragauskas, Arminasu Kaunas University of Technology, Kaunas, Lithuania4 aut
7001 a Citerio, Giuseppeu University of Milano-Bicocca, Milano, Italy4 aut
7001 a Chambers, Iainu James Cook University Hospital, Middlesbrough, United Kingdom4 aut
7001 a Neumann, Jan-Oliveru Universitätsklinikum Heidelberg, Heidelberg, Germany4 aut
7001 a Sahuquillo, Juanu University Hospital Vall d ́Hebron, Barcelona, Spain4 aut
7001 a Kiening, Karlu Universitätsklinikum Heidelberg, Heidelberg, Germany4 aut
7001 a Moss, Laurau Southern General Hospital, Glasgow, United Kingdom4 aut
7001 a Nilsson, Pelleu Uppsala universitet,Neurokirurgi4 aut0 (Swepub:uu)pellnils
7001 a Donald, Robu Stats Research, Scotland, United Kingdom4 aut
7001 a Howells, Timu Uppsala universitet,Neurokirurgi4 aut0 (Swepub:uu)timho266
7001 a Lo, Millyu University of Edinburgh, Edinburgh, United Kingdom4 aut
7001 a Depreitere, Bartu University Hospitals Leuven, Leuven, Belgium4 aut
7102 a University Hospitals Leuven, Leuven, Belgiumb Southern General Hospital, Glasgow, United Kingdom4 org
7730 t Injuryd : Elsevierg 54:9q 54:9x 0020-1383x 1879-0267
8564 8u https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-519805
8564 8u https://doi.org/10.1016/j.injury.2023.110911

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