Decompressive craniectomy for traumatic brain injury: patient age and outcome

Abstract

The overall degree by which different patients may benefit from decompressive craniectomy (DC) remains controversial. In particular, the prognostic value of age has been investigated by very few studies. Many authors state there is no significant benefit in performing a DC in severe head injury after a certain age limit, with most placing the limit at 30-50 years of age. Between 1994 and 2004, 55 patients underwent DC at our institution. Advanced age did not constitute a contraindication to surgery for both ethical and cultural reasons. Thus, the data obtained were not biased by a selection of patients based on age. We analyzed potential predictors of outcome after DC, including sex, age, Glasgow Coma Scale (GCS), and presence of mass lesion. Chi-square test was used to compare categorical variables. The independent contribution of predictive factors to outcome was studied using logistic regression analysis. Initial GCS score was found to be an independent predictor of outcome (p = 0.001). No difference in the outcome was observed between patients with GCS 6-8 and GCS 9-15. These two groups have a better prognosis than patients with GCS 3-5. Logistic regression analysis showed age as an independent predictive factor to outcome (p = 0.005). A difference in outcome exists among patients over 65 and patients aged <or=65, while groups aged <40 and 40-65 showed no difference in outcome. Based on these findings, we believe that the age limit for performing DC should be revised.