Evaluation of prognostic factors of outcome in severe traumatic brain injury patients following decompressive craniectomy

 

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Introduction: Severe traumatic brain injury (TBI) is leading cause of death and disability globally. Decompressive craniectomy (DC) is done to treat severe brain edema. We conducted a study to determine predictive factors for prognosis of DC at the time of cranioplasty. We correlated the admission variables, CT scan findings and timing of d/c, hospital stay with functional outcome. Methods: The functional outcome was noted prospectively and retrospective admission data was obtained from hospital records. All consenting patients (15-65 yrs) posted for cranioplasty following DC due to severe TBI were enrolled. The data including Marshall grading, admission Glasgow coma score (GCS), mean arterial pressure (MAP), time of DC, duration of hospital stay, hospital readmission and GCS at discharge. The functional outcome at the time of cranioplasty was measured by Glasgow Outcome Score (GOSE) questionnaire. GOSE 5-8 were classified as good outcome and GOSE 1-4 were classified as poor outcome. Results: A total 85 patients (71 male and 14 female) were enrolled. The mean age was 33.42 yrs. Only 36% patients had a good outcome (GOSE 5-8). There was no significant association between age, sex, marshall grading, duration between d/c and cranioplasty, hospital readmission, GCS at admission with outcome. In univariate analysis tracheostomy, duration of hospital stay, MAP, timing of DC and GCS at discharge were predictors of outcome. On multivariate analysis tracheostomy was found to be independent predictor of outcome. Discussion: Significant disability is seen among the survivors of DC. Admission variables do not predict outcome. Larger sample size is required.