Cargando…
Outcome of Decompressive Craniectomy for Traumatic Brain Injury: An Institutional-Based Analysis from Nepal
OBJECTIVE: Decompressive craniectomy (DC) is one of the commonly used treatment modalities for refractory intracranial hypertension after traumatic brain injury. The objective of this study is to assess the functional outcome following DC in closed traumatic brain injury based on Glasgow Outcome Sca...
Autores principales: | , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Wolters Kluwer - Medknow
2021
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8244698/ https://www.ncbi.nlm.nih.gov/pubmed/34268153 http://dx.doi.org/10.4103/ajns.AJNS_392_20 |
_version_ | 1783715982917763072 |
---|---|
author | Shah, Damber Bikram Paudel, Prakash Joshi, Sumit Karki, Prasanna Sharma, Gopal Raman |
author_facet | Shah, Damber Bikram Paudel, Prakash Joshi, Sumit Karki, Prasanna Sharma, Gopal Raman |
author_sort | Shah, Damber Bikram |
collection | PubMed |
description | OBJECTIVE: Decompressive craniectomy (DC) is one of the commonly used treatment modalities for refractory intracranial hypertension after traumatic brain injury. The objective of this study is to assess the functional outcome following DC in closed traumatic brain injury based on Glasgow Outcome Scale (GOS). MATERIALS AND METHODS: This is a retrospective study conducted at Nepal Mediciti Hospital, Nepal, from September 2017 to October 2019. Data of the patients who had undergone DC for closed traumatic brain injury were reviewed from medical record files. Patients who had DC for nontraumatic causes were excluded from the study. Functional outcome was assessed using GOS at 3 months of follow-up. RESULTS: Of the 52 decompressive craniectomies, 46 were included in the study. The majority was male (71.7%). The mean age and the mean Glasgow Coma Scale (GCS) score at presentation were 41.87 (standard deviation [SD] ± 15.29) and 7.59 (SD ± 2.97), respectively. The most common mode of injury was road traffic accident (76.1%). 60.9% had GCS score ≤8 while 39.1% had >8 GCS on admission. 34.8% had both the pupils reactive while 58.7% were anisocoric. Majority had Marshall IV and above grade of injury (67.4%). Sixteen (34.8%) had inhospital mortality. Favorable outcome was seen in 39.1%. GCS score >8 at presentation (72.2%, P < 0.001), bilaterally intact pupillary reflexes (75%, P < 0.001), Marshall grade injury ≤3 on computed tomography scan (90%, P < 0.001), and age <50 years (50%, P = 0.039) were significantly associated with favorable outcome. Procedure-related complications were seen in 36.9%. CONCLUSION: Favorable outcome was seen in 39.1%. Age <50 years, higher GCS score at presentation (>8), intact pupillary reflexes, and lower Marshall grade injuries were associated with favorable outcome. We recommend a larger prospective study to assess the long-term functional outcome after DC using extended GOS. |
format | Online Article Text |
id | pubmed-8244698 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Wolters Kluwer - Medknow |
record_format | MEDLINE/PubMed |
spelling | pubmed-82446982021-07-14 Outcome of Decompressive Craniectomy for Traumatic Brain Injury: An Institutional-Based Analysis from Nepal Shah, Damber Bikram Paudel, Prakash Joshi, Sumit Karki, Prasanna Sharma, Gopal Raman Asian J Neurosurg Original Article OBJECTIVE: Decompressive craniectomy (DC) is one of the commonly used treatment modalities for refractory intracranial hypertension after traumatic brain injury. The objective of this study is to assess the functional outcome following DC in closed traumatic brain injury based on Glasgow Outcome Scale (GOS). MATERIALS AND METHODS: This is a retrospective study conducted at Nepal Mediciti Hospital, Nepal, from September 2017 to October 2019. Data of the patients who had undergone DC for closed traumatic brain injury were reviewed from medical record files. Patients who had DC for nontraumatic causes were excluded from the study. Functional outcome was assessed using GOS at 3 months of follow-up. RESULTS: Of the 52 decompressive craniectomies, 46 were included in the study. The majority was male (71.7%). The mean age and the mean Glasgow Coma Scale (GCS) score at presentation were 41.87 (standard deviation [SD] ± 15.29) and 7.59 (SD ± 2.97), respectively. The most common mode of injury was road traffic accident (76.1%). 60.9% had GCS score ≤8 while 39.1% had >8 GCS on admission. 34.8% had both the pupils reactive while 58.7% were anisocoric. Majority had Marshall IV and above grade of injury (67.4%). Sixteen (34.8%) had inhospital mortality. Favorable outcome was seen in 39.1%. GCS score >8 at presentation (72.2%, P < 0.001), bilaterally intact pupillary reflexes (75%, P < 0.001), Marshall grade injury ≤3 on computed tomography scan (90%, P < 0.001), and age <50 years (50%, P = 0.039) were significantly associated with favorable outcome. Procedure-related complications were seen in 36.9%. CONCLUSION: Favorable outcome was seen in 39.1%. Age <50 years, higher GCS score at presentation (>8), intact pupillary reflexes, and lower Marshall grade injuries were associated with favorable outcome. We recommend a larger prospective study to assess the long-term functional outcome after DC using extended GOS. Wolters Kluwer - Medknow 2021-05-28 /pmc/articles/PMC8244698/ /pubmed/34268153 http://dx.doi.org/10.4103/ajns.AJNS_392_20 Text en Copyright: © 2021 Asian Journal of Neurosurgery https://creativecommons.org/licenses/by-nc-sa/4.0/This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms. |
spellingShingle | Original Article Shah, Damber Bikram Paudel, Prakash Joshi, Sumit Karki, Prasanna Sharma, Gopal Raman Outcome of Decompressive Craniectomy for Traumatic Brain Injury: An Institutional-Based Analysis from Nepal |
title | Outcome of Decompressive Craniectomy for Traumatic Brain Injury: An Institutional-Based Analysis from Nepal |
title_full | Outcome of Decompressive Craniectomy for Traumatic Brain Injury: An Institutional-Based Analysis from Nepal |
title_fullStr | Outcome of Decompressive Craniectomy for Traumatic Brain Injury: An Institutional-Based Analysis from Nepal |
title_full_unstemmed | Outcome of Decompressive Craniectomy for Traumatic Brain Injury: An Institutional-Based Analysis from Nepal |
title_short | Outcome of Decompressive Craniectomy for Traumatic Brain Injury: An Institutional-Based Analysis from Nepal |
title_sort | outcome of decompressive craniectomy for traumatic brain injury: an institutional-based analysis from nepal |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8244698/ https://www.ncbi.nlm.nih.gov/pubmed/34268153 http://dx.doi.org/10.4103/ajns.AJNS_392_20 |
work_keys_str_mv | AT shahdamberbikram outcomeofdecompressivecraniectomyfortraumaticbraininjuryaninstitutionalbasedanalysisfromnepal AT paudelprakash outcomeofdecompressivecraniectomyfortraumaticbraininjuryaninstitutionalbasedanalysisfromnepal AT joshisumit outcomeofdecompressivecraniectomyfortraumaticbraininjuryaninstitutionalbasedanalysisfromnepal AT karkiprasanna outcomeofdecompressivecraniectomyfortraumaticbraininjuryaninstitutionalbasedanalysisfromnepal AT sharmagopalraman outcomeofdecompressivecraniectomyfortraumaticbraininjuryaninstitutionalbasedanalysisfromnepal |