The current role of decompressive craniectomy for severe traumatic brain injury

Publication date: September 2017 Source:Journal of Clinical Neuroscience, Volume 43 Author(s): S. Honeybul, K.M. Ho, C.R.P. Lind, G.R. Gillett There is little doubt that decompressive craniectomy can reduce mortality however, the results of a recent study has provided more evidence to inform the debate regarding clinical and ethical concerns that it merely converts death into survival with severe disability or in a vegetative state. The recently published RESCUEicp trial compared last-tier secondary decompressive craniectomy with continued medical management for refractory intracranial hypertension after severe traumatic brain injury. Patients were randomly assigned to decompressive craniectomy with medical therapy or to receive continued medical therapy with the option of adding barbiturates. The results of the study support the findings of the stroke studies in that the reduction in mortality was almost directly translatable into survival with either severe disability or in a vegetative state. The question remains as to whether there is a subset of patients who obtain benefit from surgical decompression and it is in this regard that the use of observational cohort studies and sophisticated outcome prediction models may be of use. Comparing the percentage prediction with the observed long outcome provides an objective assessment of the most likely outcome can be obtained for patients thought to require surgical intervention. Whilst there will always be limitations when...
Source: Journal of Clinical Neuroscience - Category: Neuroscience Source Type: research