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Meta-Analysis
. 2017 Aug 18;7(1):8800.
doi: 10.1038/s41598-017-08959-y.

Decompressive craniectomy in the management of intracranial hypertension after traumatic brain injury: a systematic review and meta-analysis

Danfeng Zhang  1 , Qiang Xue  1 , Jigang Chen  1 , Yan Dong  1 , Lijun Hou  1 , Ying Jiang  2 , Junyu Wang  3
Affiliations
Meta-Analysis

Decompressive craniectomy in the management of intracranial hypertension after traumatic brain injury: a systematic review and meta-analysis

Danfeng Zhang et al. Sci Rep. .

Abstract

We aim to perform a systematic review and meta-analysis to examine the prognostic value of decompressive craniectomy (DC) in patients with traumatic intracranial hypertension. PubMed, EMBASE, Cochrane Controlled Trials Register, Web of Science, http://clinicaltrials.gov/ were searched for eligible studies. Ten studies were included in the systematic review, with four randomized controlled trials involved in the meta-analysis, where compared with medical therapies, DC could significantly reduce mortality rate [risk ratio (RR), 0.59; 95% confidence interval (CI), 0.47-0.74, P < 0.001], lower intracranial pressure (ICP) [mean difference (MD), -2.12 mmHg; 95% CI, -2.81 to -1.43, P < 0.001], decrease the length of ICU stay (MD, -4.63 days; 95% CI, -6.62 to -2.65, P < 0.001) and hospital stay (MD, -14.39 days; 95% CI, -26.00 to -2.78, P = 0.02), but increase complications rate (RR, 1.94; 95% CI, 1.31-2.87, P < 0.001). No significant difference was detected for Glasgow Outcome Scale at six months (RR, 0.85; 95% CI, 0.61-1.18, P = 0.33), while in subgroup analysis, early DC would possibly result in improved prognosis (P = 0.04). Results from observational studies supported pooled results except prolonged length of ICU and hospital stay. Conclusively, DC seemed to effectively lower ICP, reduce mortality rate but increase complications rate, while its benefit on functional outcomes was not statistically significant.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Figure 1
Figure 1
Flow diagram of study selection.
Figure 2
Figure 2
Forest plots for the effect of DC versus NON-DC on overall mortality. DC, Decompressive Craniectomy.
Figure 3
Figure 3
Forest plots for the effect of DC versus NON-DC on GOS scores at 6 months. DC, Decompressive Craniectomy; GOS, Glasgow Outcome Scale.
Figure 4
Figure 4
Forest plots for the effect of DC versus NON-DC on ICP reduction. DC, Decompressive Craniectomy; ICP, Intracranial Pressure.
Figure 5
Figure 5
Forest plots for the effect of DC versus NON-DC on length of ICU and hospital stay. (A) length of ICU stay; (B) Length of hospital stay. DC, Decompressive Craniectomy; ICU, intensive care unit.
Figure 6
Figure 6
Forest plots for the effect of DC versus NON-DC on complications. DC, Decompressive Craniectomy.
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