Some Benefits for Decompressive Craniectomy in TBI
Lower mortality; higher rates of vegetative state and lower, upper severe disability versus medical care
THURSDAY, Sept. 8, 2016 (HealthDay News) -- For patients with traumatic brain injury and refractory elevated intracranial hypertension, decompressive craniectomy results in lower mortality than medical care, according to a study published online Sept. 7 in the New England Journal of Medicine.
Peter J. Hutchinson, Ph.D., from the University of Cambridge in the United Kingdom, and colleagues randomized 408 patients, aged 10 to 65 years, with traumatic brain injury and refractory elevated intracranial pressure to undergo decompressive craniectomy or receive ongoing medical care.
The researchers observed a significant between-group difference in the Extended Glasgow Outcome Scale (GOS-E) distribution (P < 0.001). GOS-E distributions at six months were: death, 26.9 versus 48.9 percent in the surgical group versus medical group; vegetative state, 8.5 versus 2.1 percent; lower severe disability, 21.9 versus 14.4 percent; upper severe disability, 15.4 versus 8.0 percent; moderate disability, 23.4 versus 19.7 percent; and good recovery, 4.0 versus 6.9 percent. The GOS-E distributions at 12 months were: death, 30.4 versus 52.0 percent; vegetative state, 6.2 versus 1.7 percent; lower severe disability, 18.0 versus 14.0 percent; upper severe disability, 13.4 versus 3.9 percent; moderate disability, 22.2 versus 20.1 percent; and good recovery, 9.8 versus 8.4 percent.
"At six months, decompressive craniectomy in patients with traumatic brain injury and refractory intracranial hypertension resulted in lower mortality and higher rates of vegetative state, lower severe disability, and upper severe disability than medical care," the authors write.