Introduction: A retrospective study measuring the outcomes post-decompressive craniectomy done for cases of traumatic head injury in a single centre.
Methods: Search of theatre cases where decompressive craniectomy has been done for trauma between years 2006 and 2013. Patient data collected include age and gender. Clinical details include the GCS on admission, time to surgery, type of decompression, presence of intracranial clots and intraparenchymal contusions, length of hospital and ICU stay. Glasgow outcome scores (GOS) were measured at time of discharge and on last follow up.
Results: 62 patients underwent decompressive craniectomy for trauma with a median presenting GCS of 6. 12 patients had a GCS of 3 on arrival of which 42% died. There were 16 deaths in total accounting for 25.8% of all cases. 87% of cases had evidence of diffused axonal injury or intraparenchymal contusions on CT. Average time to decompressive was 28.7 hours. Average length of hospital stay was 19.5 days, with ICU stay averaging 6.5 days. 67.4% of patients who survived had a GOS of at least 4.
Conclusions: Decompressive craniectomy is a viable option for treating raised intracranial pressures that are refractory to medical management. Patient selection is important however in spite of this the mortality rate of severe head trauma remains significant.
Patient Care: Aids decision making and guides prognostication in cases of severe head injury
Learning Objectives: The usefullness of decompressive craniectomy as a surgical option to manage increased intracranial pressure as well as the complications and outcomes one might expect for a patient having such a procedure in the context of severe head trauma.