Mortality and outcomes after decompressive craniectomy in children with severe traumatic brain injury

Purpose: The effect of decompressive craniectomy (DC) on mortality and outcomes in children with elevated intracranial pressure after severe head trauma is strongly debated and high-quality evidence is lacking. This study was conducted to determine whether DC in children with severe head trauma is associated with a decrease in mortality or poor outcomes at discharge from the intensive care unit. Methods: Data on patients < 18 years of age treated in Germany, Austria, and Switzerland during a ten-year period were extracted from TraumaRegister DGU®, forming a retrospective multi-centre cohort study. Descriptive and multivariable analyses were performed to compare mortality and outcomes after decompressive craniectomy and medical management. Results: 2507 patients were included, of which 402 underwent decompressive craniectomy. Mortality was 20.6 % in children undergoing DC compared to 13.7 % after medical management. Observed and predicted mortality after DC and medical management matched in all subgroups except in children between six and 17 years of age, where mortality after DC was lower than predicted. Poor outcome was observed in 27.6 % of DC patients vs. 16.1 % receiving medical management. Logistic regression revealed slightly negative effects of DC on mortality (odds ratio 1.20, not significant) and outcomes (odds ratio 1.56 (95% confidence interval 1.01-2.40). Conclusion: DC did not decrease overall mortality or rates of poor outcome. However, children above six years of age may benefit from DC. High quality prospective studies are urgently needed.

Cranioplasty Flap Lifting Caused by Intracranial Hypertension Literature Review

Cranioplasty is a neurosurgical technique that replaces a bone defect in the skull with hard replacement tissue. It is indicated in particular after a decompressive craniectomy performed in severe head trauma in order to control intracranial hypertension refractory to medical treatment. Cranioplasty is sometimes associated with a significant number of complications, including hydrocephalus. In this article, we report the case of a cranioplasty flap lifting on intracranial hypertension following postoperative hydrocephalus and discuss the clinical relevance with a review of the literature.

Can the mean platelet volume predict the mortality of patients with head trauma?

Objective: Prediction of mortality in the patient of the intensive care unit is essential. It was aimed to study the mortality predictive value of mean platelet volume (MPV) in patients with severe head trauma. Study design: The mean platelet volumes were measured in patients with head injury managed intensive care unit between 1 December 2017 and 1 January 2019 at admission and exitus date. Methods: The main outcome variable was mortality due to the traumatic event of patients. 43 patients with head trauma admitted to the intensive care unit during the study period. 17 patients died (Group I), 26 survived (Group II). Results: There was not an association between MPV and mortality at admission. However, Cox regression analysis showed that late MPV (at exitus or discharged date), WBC at admission, and age increase the mortality rate 1,770, 1,202, 1,052 times, respectively. Conclusion: The present study shows that MPV may be a useful predictor of mortality in the patient with severe head trauma. More detailed studies are needed.

The Relationship of Blood Gas Values With Prognosis in Pediatric Patients With Severe Head Trauma

Purpose:Severe head traumas in the childhood age group has an important place in terms of mortality and morbidity among all traumas. Our aim in this study is to consider the relationship between the severity of severe head trauma and arterial blood gas (ABG) parameter levels in children.Methods:In our study, patients with head trauma, intubation and Glascow Coma Score (GCS) ≤ 8 were retrospectively analyzed. Showing homogeneous distribution; Independent sample T test was used for pH, PCO2 and base extract (BE) parameters, and Mann Whitney U test was used for PO2 and lactate parameters not showing homogeneous distribution. ROC analysis was done.Results:Of the 48 patients included in the study, 17 died while lying in the intensive care unit. There was no statistical difference when looking at the relationship between age, gender, surgical methods and mortality of the patients (p> 0.05). The relationship of patients with acidosis, hypercapnia and hyperlactatemia in ABG with mortality was statistically significant (p˂0.05). No statistically significant difference was found between surviving and deceased in ABG of patients regarding BE and hypoxia (p= 0.075; 0.175). there was a statistically significant difference between the mean values of PCO2 and lactate which are among the quantitative values and those who survived and died (p <0.05).Conclusion: Acidosis, the presence hypercapnia and hyperlactatemia were found to be associated with mortality in children with severe head trauma in ABG analysis. This study shows that PCO2 and lactate levels in ABG can be a biomarker in determining the prognosis in pediatric patients with traumatic brain injury (TBI).