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Decompressive craniectomy in severe traumatic brain injury: prognostic factors and complications

OBJECTIVE: To analyze the clinical characteristics, complications and factors associated with the prognosis of severe traumatic brain injury among patients who undergo a decompressive craniectomy. METHODS: Retrospective study of patients seen in an intensive care unit with severe traumatic brain inj...

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Autores principales: Grille, Pedro, Tommasino, Nicolas
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Associação Brasileira de Medicina intensiva 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4489778/
https://www.ncbi.nlm.nih.gov/pubmed/26340150
http://dx.doi.org/10.5935/0103-507X.20150021
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author Grille, Pedro
Tommasino, Nicolas
author_facet Grille, Pedro
Tommasino, Nicolas
author_sort Grille, Pedro
collection PubMed
description OBJECTIVE: To analyze the clinical characteristics, complications and factors associated with the prognosis of severe traumatic brain injury among patients who undergo a decompressive craniectomy. METHODS: Retrospective study of patients seen in an intensive care unit with severe traumatic brain injury in whom a decompressive craniectomy was performed between the years 2003 and 2012. Patients were followed until their discharge from the intensive care unit. Their clinical-tomographic characteristics, complications, and factors associated with prognosis (univariate and multivariate analysis) were analyzed. RESULTS: A total of 64 patients were studied. Primary and lateral decompressive craniectomies were performed for the majority of patients. A high incidence of complications was found (78% neurological and 52% nonneurological). A total of 42 patients (66%) presented poor outcomes, and 22 (34%) had good neurological outcomes. Of the patients who survived, 61% had good neurological outcomes. In the univariate analysis, the factors significantly associated with poor neurological outcome were postdecompressive craniectomy intracranial hypertension, greater severity and worse neurological state at admission. In the multivariate analysis, only postcraniectomy intracranial hypertension was significantly associated with a poor outcome. CONCLUSION: This study involved a very severe and difficult to manage group of patients with high morbimortality. Intracranial hypertension was a main factor of poor outcome in this population.
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spelling pubmed-44897782015-07-07 Decompressive craniectomy in severe traumatic brain injury: prognostic factors and complications Grille, Pedro Tommasino, Nicolas Rev Bras Ter Intensiva Original Article OBJECTIVE: To analyze the clinical characteristics, complications and factors associated with the prognosis of severe traumatic brain injury among patients who undergo a decompressive craniectomy. METHODS: Retrospective study of patients seen in an intensive care unit with severe traumatic brain injury in whom a decompressive craniectomy was performed between the years 2003 and 2012. Patients were followed until their discharge from the intensive care unit. Their clinical-tomographic characteristics, complications, and factors associated with prognosis (univariate and multivariate analysis) were analyzed. RESULTS: A total of 64 patients were studied. Primary and lateral decompressive craniectomies were performed for the majority of patients. A high incidence of complications was found (78% neurological and 52% nonneurological). A total of 42 patients (66%) presented poor outcomes, and 22 (34%) had good neurological outcomes. Of the patients who survived, 61% had good neurological outcomes. In the univariate analysis, the factors significantly associated with poor neurological outcome were postdecompressive craniectomy intracranial hypertension, greater severity and worse neurological state at admission. In the multivariate analysis, only postcraniectomy intracranial hypertension was significantly associated with a poor outcome. CONCLUSION: This study involved a very severe and difficult to manage group of patients with high morbimortality. Intracranial hypertension was a main factor of poor outcome in this population. Associação Brasileira de Medicina intensiva 2015 /pmc/articles/PMC4489778/ /pubmed/26340150 http://dx.doi.org/10.5935/0103-507X.20150021 Text en http://creativecommons.org/licenses/by-nc/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution NonCommercial License which permits unrestricted noncommercial use, distribution, and reproduction in any medium provided the original work is properly cited.
spellingShingle Original Article
Grille, Pedro
Tommasino, Nicolas
Decompressive craniectomy in severe traumatic brain injury: prognostic factors and complications
title Decompressive craniectomy in severe traumatic brain injury: prognostic factors and complications
title_full Decompressive craniectomy in severe traumatic brain injury: prognostic factors and complications
title_fullStr Decompressive craniectomy in severe traumatic brain injury: prognostic factors and complications
title_full_unstemmed Decompressive craniectomy in severe traumatic brain injury: prognostic factors and complications
title_short Decompressive craniectomy in severe traumatic brain injury: prognostic factors and complications
title_sort decompressive craniectomy in severe traumatic brain injury: prognostic factors and complications
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4489778/
https://www.ncbi.nlm.nih.gov/pubmed/26340150
http://dx.doi.org/10.5935/0103-507X.20150021
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