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. 2018 Feb;160(2):229-237.
doi: 10.1007/s00701-017-3418-3. Epub 2017 Dec 12.

Decompressive craniectomy in traumatic brain injury: usage and clinical outcome in a single centre

Teodor Svedung Wettervik  1 , Samuel Lenell  2 , Lena Nyholm  2 , Tim Howells  2 , Anders Lewén  2 , Per Enblad  2
Affiliations

Decompressive craniectomy in traumatic brain injury: usage and clinical outcome in a single centre

Teodor Svedung Wettervik et al. Acta Neurochir (Wien). 2018 Feb.

Abstract

Background: Two randomised controlled trials (RCTs) of decompressive craniectomy (DC) in traumatic brain injury (TBI) have shown poor outcome, but there are considerations of how these protocols relate to real practice. The aims of this study were to evaluate usage and outcome of DC and thiopental in a single centre.

Method: The study included all TBI patients treated at the neurointensive care unit, Akademiska sjukhuset, Uppsala, Sweden, between 2008 and 2014. Of 609 patients aged 16 years or older, 35 treated with DC and 23 treated with thiopental only were studied in particular. Background variables, intracranial pressure (ICP) measures and global outcome were analysed.

Results: Of 35 DC patients, 9 were treated stepwise with thiopental before DC, 9 were treated stepwise with no thiopental before DC and 17 were treated primarily with DC. Six patients received thiopental after DC. For 23 patients, no DC was needed after thiopental. Eighty-eight percent of our DC patients would have qualified for the DECRA study and 38% for the Rescue-ICP trial. Favourable outcome was 44% in patients treated with thiopental before DC, 56% in patients treated with DC without prior thiopental, 29% in patients treated primarily with DC and 52% in patients treated with thiopental with no DC.

Conclusions: The place for DC in TBI management must be evaluated better, and we believe it is important that future RCTs should have clearer and less permissive ICP criteria regarding when thiopental should be followed by DC and DC followed by thiopental.

Keywords: Decompressive craniectomy; Neurointensive care; Standardised treatment protocol; Thiopental; Traumatic brain injury.

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Conflict of interest statement

Conflicts of interest

The authors declare that they have no conflict of interest.

Research involving human participants and animals

All procedures performed in studies involving humans were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

Informed consent

Informed consent was obtained from the relatives of all participating patients.

Figures

Fig. 1
Fig. 1
Clinical outcome after thiopental and DC. The bars named with DECRA or Rescue-ICP were based on data from those studies [2, 8]. The other bars were from the study groups of this article. Favourable outcome was defined as GOS-E 5–8 and unfavourable outcome as GOS-E 1–4
See this image and copyright information in PMC

Comment in

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