D. Agarwal1, V. K. Rajajee2, D. Schoubel2, M. C. Misra1, K. Raghavendran2 1All India Institute Of Medical Sciences,Apex Trauma Institute,New Delhi, , India 2University Of Michigan,Ann Arbor, MI, USA
Introduction: Severe Traumatic Brain Injury (TBI) is a problem of epidemic proportion in the developing world. The use of Decompressive Craniectomy (DC) may decrease the subsequent need for resources directed at Intracranial Pressure (ICP) control and ICU length of stay, important considerations in resource-constrained environments. The impact of DC on outcomes, however, is unclear.The primary objective of the study was to determine the impact of DC on in-hospital mortality and 6-month functional outcomes following severe TBI in a resource-constrained setting at the JPNATC, AIIMS, New Delhi, India.
Methods: During a 4-year period data was prospectively entered into a severe TBI registry. Patients aged >12-years meeting criteria for ICP monitoring (ICPM) were included. The registry was queried for known predictors of outcome in addition to use of ICPM and DC. Early DC (eDC) was defined as DC performed <48 hours from injury. Outcomes of interest were in-hospital mortality and poor 6-month functional outcome with Glasgow Outcome Scale (GOS)<3. A propensity-score based analysis was utilized to examine the impact of DC on outcomes.
Results: Of 1345 patients meeting study criteria, 589 (44%) underwent DC. Following propensity-score based analysis, DC was associated with a 9.2% increase (p=0.005) in mortality and a 13.2% increase (p=0.016) in poor 6-month outcome, while eDC was associated with a 15.0% (p<0.0001) increase in mortality but not significantly associated with poor 6-month outcome (p=0.15).
Conclusions: The use of DC following severe TBI was associated with an increased likelihood of in-hospital death and poor 6-month functional outcome in a high-volume resource-constrained setting. Clinical trials of DC in similar settings are warranted to determine the impact of DC in severe TBI.
