[Risk factors of unfavorable outcome after decompressive craniectomy in children with severe traumatic brain injury].

Abstract

Although the first publication devoted to early decompressive craniectomy in children with TBI and refractory intracranial hypertension occurred more than two decades ago, the issue of effectiveness and functional outcomes continues to be discussed. Variability of data and methods for assessing the effectiveness of decompressive craniectomy in children with severe TBI does not allow for convincing recommendations.

Objective: To identify the risk factors of unfavorable outcomes after decompressive craniectomy in children with severe TBI.

Material and methods: The study included 64 patients with refractory intracranial hypertension over 20 mm Hg. Age, GCS score at admission, GOS grade after 6 months, intracranial pressure and cerebral perfusion pressure before surgery, energy of ICP fluctuations process-E², pupil status and ISS score were analyzed. Treatment outcomes were assessed after 6 months.

Results: GOS grade 4-5 was observed in 45.3% of cases, grade 3 - in 31% of cases, grade 1-2 - in 23.4% of cases. Mortality rate was 18.7% (12 patients). There are significant predictors of unfavorable outcome: GCS score, ICP ≥40 mm Hg, wide pupils, impaired photoreaction, type of injury (isolated/combined), midline shift (p<0.05).

Conclusion: Risk factors of unfavorable outcome after decompressive craniectomy in children include independent factors (severity of primary brain injury) and controllable factors (ICP and its derivatives). ICP ≥40 mm Hg increases the risk of unfavorable outcome after decompressive craniectomy. Decompressive craniectomy is a preventive measure and should be considered as a tool for dislocation syndrome control.