Long-term outcome and health status in decompressive craniectomized patients with intractable intracranial pressure after severe brain injury

Abstract

Objective: Decompressive craniectomy (DC) in severe traumatic brain injury (TBI) remains a controversial therapeutic strategy. The long-term functional recovery and health status in a sample of decompressive craniectomized TBI are reported.

Methods: Patients with TBI who underwent DC were retrospectively investigated. Patients with cerebral haemorrhage (CH) and DC were considered as control group. In all survival patients admitted to a neuro-rehabilitation setting, the modified Rankin (mRS), Glasgow Outcome scale (GOS) and Barthel Scales (BS) were administered at admission, discharge, 1 year and follow-up. The quality-of-life was evaluated with the SF-36 questionnaire at follow-up (41.1 ± 16.6 months).

Results: Seventy (33 F, 37 M, mean age = 46.8, SD = 18.8) patients were enrolled: 46 (20 F, 26 M) subjects with TBI and 24 (13 F, 11 M) with CH. After surgery, 11 (23.9%) and 10 (41.6%) subjects in the TBI and CH group, respectively, died. The mean Barthel scores were 4.0 (SD = 5.9), 60.9 (SD = 37.5), 63.7 (SD = 35.1) and 67.3 (SD = 38.2) (p < 0.001) and median GOS was 3, 4, 4 and 4 at admission, discharge, 1 year and follow-up, respectively, in TBI patients. Seventeen (36.9%) patients with TBI and four (16.6%) with CH made a full recovery. The SF-36 questionnaire showed significant abnormalities in all domains of health status in both groups.

Conclusion: Craniectomized patients with TBI achieved good long-term outcome, although they experienced significant difficulties in health status.

• Decompressive craniectomy
• traumatic brain injury
• outcome
• rehabilitation
• health status