![]() Some factors associated with a poor prognosis after DC have been identified, including the initial Glasgow Score Scale (GCS) and the pupillary status after trauma or on admission ( 13– 17). The latest edition of the relevant guidelines provides the indications for and approaches to DC in patients with intractable ICP that is refractory to conservative treatment (secondary DC) and/or various types of intracranial lesions (primary DC) ( 9).Īlthough DC has saved innumerable lives in the past decades, the high postoperative mortality and disability rates in severely injured patients are not only devastating to patients and their family members but also challenging for neurosurgeons ( 10– 12). The treatments, rehabilitation therapy, and permanent sequelae associated with TBI impose a substantial economic burden on patients' families and have profound impacts on society ( 5, 6).ĭecompressive craniectomy (DC), with or without the removal of the intracranial hematoma, plays a pivotal role in the treatment of patients with TBI with substantial mass lesions or uncontrolled elevation of the intracranial pressure (ICP) ( 7, 8). China has more cases of TBI than many other counties, making it almost impossible to implement a nationwide epidemiological investigation ( 3, 4). Traumatic brain injury (TBI), which is a significant public health issue, has become the main cause of trauma-related death and disability worldwide ( 1, 2). DC is more valuable for younger patients. In multivariate analysis, advanced age (OR: 7.741, CI: 2.288–26.189), prolonged preoperative activated partial thromboplastin time (aPTT) (OR: 7.263, CI: 1.323–39.890), and low GCS (OR: 6.162, CI: 1.478–25.684) were associated with a higher risk of 30-day mortality, while advanced age (OR: 8.812, CI: 1.817–42.729) was the only independent predictor of a poor 6-month prognosis in patients undergoing DC with preoperative bilateral dilated pupils and a GCS score <5.Ĭonclusions: The mortality and disability rates are extremely high in severe TBI patients undergoing emergency DC with bilateral fixed pupils and a GCS score <5. In total, 74 patients (78.7%) died within 30 days, and 84 (89.4%) had a poor 6-month outcome (GOS 1–2). Results: A total of 94 sTBI patients with bilateral dilated pupils and a GCS score lower than five who underwent emergency DC were enrolled. Multivariate logistic regression analysis was performed to determine the factors associated with 30-day mortality and 6-month negative neurological outcome. All data, such as patient demographics, radiological findings, clinical parameters, and preoperative laboratory variables, were extracted. Methods: The authors reviewed the data from patients who underwent emergency DC from January 2012 to March 2019 in a medical center in China. This retrospective study explored the clinical outcomes and risk factors for an unfavorable prognosis in sTBI patients undergoing emergency DC with bilateral dilated pupils and a GCS score <5. However, whether DC should be performed in patients with bilateral dilated pupils and a low Glasgow Coma Scale (GCS) score is still controversial. Objective: Decompressive craniectomy (DC) plays an important role in the treatment of patients with severe traumatic brain injury (sTBI) with mass lesions and intractably elevated intracranial hypertension (ICP). Department of Neurosurgery, Ganzhou People's Hospital, Ganzhou, China.Zhiji Tang †, Ruijin Yang †, Jinshi Zhang, Qianliang Huang, Xiaoping Zhou, Wenjin Wei and Qiuhua Jiang *
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