Comparative Radiographic Factors Predicting Functional Outcome after Decompressive Craniectomy in Severe Traumatic Brain Injury.

Comparative Radiographic Factors Predicting Functional Outcome after Decompressive Craniectomy in Severe Traumatic Brain Injury.:

Related Articles

Comparative Radiographic Factors Predicting Functional Outcome after Decompressive Craniectomy in Severe Traumatic Brain Injury.

World Neurosurg. 2020 Apr 03;:

Authors: Fatima N, Mohamed ME, De Leon A, El Beltagi A, Shuaib A, Saqqur M

Abstract

OBJECTIVES: Decompressive Craniectomy (DC) is a last-tier therapy in the treatment of raised intracranial pressure (ICP) after traumatic brain injury (TBI). We report the association of comparative radiographic factors in predicting functional outcomes after DC in patients with severe TBI.

METHODS: A retrospective analysis of a prospectively maintained database between 2015-2018 at an academic tertiary care hospital was carried out. Univariate and multivariable regression analyses were performed for an array of comparative radiographic variables (pre- and post- DC) in relationship to functional outcome according to Glasgow Outcome Scale Extended (GOSE) at 180 days. GOSE was further dichotomized into favorable (GOSE:5-8) and unfavorable (GOSE:0-4) functional outcomes. All associations were reported as odds ratio (OR) with 95% confidence interval (CI).

RESULTS: Statistical analysis included a cohort of 43 patients with a median age of 30.5 years (range, 18-62 years). The median GOSE at 180 days was 7. Multivariable regression analysis after adjusting for confounding variables (age, gender, co-morbidities, site of surgery and size of decompression) showed that comparative radiographic findings of (i) midline shift (MLS) >10mm [OR:3.2 (95% CI: 1.25-8.04);p=0.01], (ii) external cerebral herniation (ECH) >2.5cm [OR:2.5(95% CI: 1.18-5.2);p=0.02], and (iii) effacement of basal cisterns [OR:3.9(95%CI: 1.1-13.9);p=0.03], were significant independent predictors of poor functional outcome at 180-days after DC for severe TBI. However, the presence of infarction [OR:2.7(95%CI:0.43-17.2);p=0.28] and absence of grey-white matter differentiation [OR:0.18(95%CI:0.03-1.2);p=0.07] did not reach statistical significance.

CONCLUSIONS: The comparative radiographic findings which include, MLS>10mm, ECH>2.5cm, and effacement of basal cisterns are predictive of poor functional outcome in severe TBI.

PMID: 32251815 [PubMed - as supplied by publisher]