K. Hanna1, M. Ditillo1, C. Zaldivar1, M. Avilla1, T. Lin1, L. Castanon1, S. Asmar1, B. Joseph1 1University of Arizona,Trauma Critical Care Burns And Emergency Surgery,Tucson, ARIZONA, USA
Introduction:
Decompressive craniectomy (DC) may be performed to control intracranial-pressure following a traumatic brain injury (TBI). The effect of DC relative to craniotomy (CO) remains unexplored in children. The aim of our study is to compare outcomes in pediatric TBI patients undergoing DC versus CO.
Methods:
We performed a (2011-2015) analysis of the Nationwide Readmission Database. We identified children (<18y) with isolated severe TBI (head-AIS≥3 & extracranial-AIS<3). Patients were stratified: those who underwent CO, those who underwent DC, and those who underwent neither procedure. Outcome measures included 6-months mortality, 6-months readmission, functional impairment, and major-complications. Multivariable regression analysis was performed
Results:
We reviewed 28,997 patients of which 1456 underwent CO, 289 underwent DC, and 27,253 underwent neither procedure. Mean age was 8±6y and the median head-AIS was 3[3-4]. Overall, 3.4% of the patients died and 4% had functional impairment. After adjusting for age, gender, body regions-AIS, ISS, patients in the DC group had a lower risk of mortality relative to the DC and conservatively managed groups (p=0.01) Table-1. They also had a lower risk of functional impairment (p=0.02). However, the risk of 6-months readmission was higher in the DC group (p=0.01). There was no significant differences in the risk of major complications (p=0.87)
Conclusion:
DC appears to be superior to CO for the treatment of severe TBI in children in terms of survival and functionality
