Prognostic analysis of emergency decompressive craniectomy for severe traumatic brain injury patients with bilateral fixed dilated pupils.

Dec 14, 2020

Contributor: Runfa Tian,Jinqian Dong,Weiming Liu,Ji Zhang,Feifei Han,Bin Zhang,Xiaojian Xu,Fei Niu,Baiyun Liu

Prognostic analysis of emergency decompressive craniectomy for severe traumatic brain injury patients with bilateral fixed dilated pupils.

For severe traumatic brain injury (sTBI) patients with bilateral fixed dilated pupils (BFDP), the value of aggressively decompressive craniectomy (DC) treatment is still controversial. The objective of this study was to analyze and validate the outcome of DC in sTBI patients with BFDP.
We retrospectively collected data from 44 sTBI patients with BFDP and underwent DC treatment during time period of July 2011 to June 2018. Outcomes used as indicators were mortality and favorable outcome. The analysis was based on the Glasgow Outcome Scale recorded at discharge, 6 and 12 months after trauma.
The overall survival rate was 36.4% (16/44) at discharge and 25.0% (11/44) at 6 and 12 months, and the favorable outcome (GOS = 4-5) at discharge, 6 and 12 months after injury was 9.1% (4/44), 13.6% (6/44) and 20.5% (9/44), respectively. Sex (p = 0.046), pre-operation GCS (p = 0.031), injury-surgery intervals (p = 0.022) and tracheotomy (p = 0.017) were independent associations to 6 and 12 months follow-up survival rate, while only pre-operation GCS (OR=6.088, CI= 1.172-31.612; p = 0.032) and injury-surgery intervals (OR = 0.241, CI = 0.065-0.893; p = 0.033) were independent associations to 12 months follow-up favorable outcome.
BFDP indicates a grave prognostic sign following sTBI, but the higher pre-operation GCS score and shorter injury-surgery intervals underwent DC treatment might independently predicting favorable outcome for sTBI patients with BFDP, and patients might be benefit much more than we thought if the DC treatment been applied more aggressively and positively.

Copyright © 2020 Elsevier Inc. All rights reserved.

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About The Expert

Runfa Tian

Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, P R China; Beijing Key Laboratory of Central Nervous System Injury, Beijing Neurosurgical Institute, Capital Medical University, Beijing 100050, P R China; Nerve injury and repair center of Beijing Institute for Brain Disorders, Beijing 100050, P R China; China National Clinical Research Center for Neurological Diseases, Beijing 100050, P R China.

Jinqian Dong

Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, P R China; Beijing Key Laboratory of Central Nervous System Injury, Beijing Neurosurgical Institute, Capital Medical University, Beijing 100050, P R China; Nerve injury and repair center of Beijing Institute for Brain Disorders, Beijing 100050, P R China; China National Clinical Research Center for Neurological Diseases, Beijing 100050, P R China.

Weiming Liu

Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, P R China; Beijing Key Laboratory of Central Nervous System Injury, Beijing Neurosurgical Institute, Capital Medical University, Beijing 100050, P R China; Nerve injury and repair center of Beijing Institute for Brain Disorders, Beijing 100050, P R China; China National Clinical Research Center for Neurological Diseases, Beijing 100050, P R China.

Ji Zhang

Department of Neurosurgery, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, P R China.

Feifei Han

Department of Diagnostics, Clinical College, Xuzhou Medical University, Xuzhou 221004, P R China.

Bin Zhang

Beijing Key Laboratory of Central Nervous System Injury, Beijing Neurosurgical Institute, Capital Medical University, Beijing 100050, P R China; Nerve injury and repair center of Beijing Institute for Brain Disorders, Beijing 100050, P R China; China National Clinical Research Center for Neurological Diseases, Beijing 100050, P R China.

Xiaojian Xu

Beijing Key Laboratory of Central Nervous System Injury, Beijing Neurosurgical Institute, Capital Medical University, Beijing 100050, P R China; Nerve injury and repair center of Beijing Institute for Brain Disorders, Beijing 100050, P R China; China National Clinical Research Center for Neurological Diseases, Beijing 100050, P R China.

Fei Niu

Beijing Key Laboratory of Central Nervous System Injury, Beijing Neurosurgical Institute, Capital Medical University, Beijing 100050, P R China; Nerve injury and repair center of Beijing Institute for Brain Disorders, Beijing 100050, P R China; China National Clinical Research Center for Neurological Diseases, Beijing 100050, P R China.

Baiyun Liu

Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, P R China; Beijing Key Laboratory of Central Nervous System Injury, Beijing Neurosurgical Institute, Capital Medical University, Beijing 100050, P R China; Nerve injury and repair center of Beijing Institute for Brain Disorders, Beijing 100050, P R China; China National Clinical Research Center for Neurological Diseases, Beijing 100050, P R China. Electronic address: liubaiyun1212@163.com.

References

PubMed