M Jamous1,2, M Barbarawi3, S Samrah4, M N Khabaz5, M Al-Jarrah6, S Dauod3. 1. Department of Neurosciences, Jordan University of Science and Technology, Irbid, Jordan. mojamous@yahoo.com. 2. Department of Neurosurgery, Faculty of Medicine, Jordan University of Science and Technology, Irbid, P.O.Box 3030, Irbid, 22110, Jordan. mojamous@yahoo.com. 3. Department of Neurosciences, Jordan University of Science and Technology, Irbid, Jordan. 4. Intensive Care Medicine, Jordan University of Science and Technology, Irbid, Jordan. 5. Department of Pathology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan. 6. Physiotherapy Department, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan.
Abstract
BACKGROUND: Trauma patients with Glasgow Coma Scale (GCS) of 3 and bilateral fixed dilated pupils (BFDP) usually have dismal outcome, and neurosurgeons are less likely to treat such patients aggressively. In this work, the authors assessed whether emergency decompressive craniectomy (EDC) can change the poor outcome of these patients. METHODS: We reviewed all patients with GCS of 3 and BFDP admitted to our neurosurgical unit from January 2004 to January 2008. Injury data, prehospital times, findings on brain computed tomography (CT) scan, procedures, and outcomes were recorded. RESULTS: During this period, 21 patients were admitted with GCS of 3 and BFDP following traumatic brain injury (TBI). Brain CT scan showed diffuse brain edema in 17 patients (81%), and in 13 patients (62%) it showed different types of intracranial hemorrhage. All patients received conservative medical treatment. Urgent decompressive bifrontal craniectomy was performed in five patients at a mean of 4.6 h (range 2-6 h) from time of injury. Intracranial pressure (ICP) was recorded hourly by intraparenchymal sensor (Codman, Johnson & Johnson). Although decompressive craniectomy was effective in controlling ICP, all patients with GCS of 3 and BFDP died within 30 days of trauma. CONCLUSIONS: Despite control of ICP following emergency decompressive craniectomy in patients with severe TBI, GCS of 3, and BFDP, this did not change the dismal outcome of these patients; on the contrary, it may increase the suffering for patients and their families and add unnecessary medical burden. We propose that these patients have irreversible severe brain insult.
BACKGROUND:Traumapatients with Glasgow Coma Scale (GCS) of 3 and bilateral fixed dilated pupils (BFDP) usually have dismal outcome, and neurosurgeons are less likely to treat such patients aggressively. In this work, the authors assessed whether emergency decompressive craniectomy (EDC) can change the poor outcome of these patients. METHODS: We reviewed all patients with GCS of 3 and BFDP admitted to our neurosurgical unit from January 2004 to January 2008. Injury data, prehospital times, findings on brain computed tomography (CT) scan, procedures, and outcomes were recorded. RESULTS: During this period, 21 patients were admitted with GCS of 3 and BFDP following traumatic brain injury (TBI). Brain CT scan showed diffuse brain edema in 17 patients (81%), and in 13 patients (62%) it showed different types of intracranial hemorrhage. All patients received conservative medical treatment. Urgent decompressive bifrontal craniectomy was performed in five patients at a mean of 4.6 h (range 2-6 h) from time of injury. Intracranial pressure (ICP) was recorded hourly by intraparenchymal sensor (Codman, Johnson & Johnson). Although decompressive craniectomy was effective in controlling ICP, all patients with GCS of 3 and BFDP died within 30 days of trauma. CONCLUSIONS: Despite control of ICP following emergency decompressive craniectomy in patients with severe TBI, GCS of 3, and BFDP, this did not change the dismal outcome of these patients; on the contrary, it may increase the suffering for patients and their families and add unnecessary medical burden. We propose that these patients have irreversible severe brain insult.
Entities:
Keywords:
Decompressive craniectomy; Fixed dilated pupils; GCS of 3; Severe brain injury
Authors: G P De Luca; L Volpin; U Fornezza; P Cervellini; M Zanusso; L Casentini; D Curri; M Piacentino; G Bozzato; F Colombo Journal: Acta Neurochir Suppl Date: 2000
Authors: R Bullock; R M Chesnut; G Clifton; J Ghajar; D W Marion; R K Narayan; D W Newell; L H Pitts; M J Rosner; J W Wilberger Journal: Eur J Emerg Med Date: 1996-06 Impact factor: 2.799
Authors: A Taylor; W Butt; J Rosenfeld; F Shann; M Ditchfield; E Lewis; G Klug; D Wallace; R Henning; J Tibballs Journal: Childs Nerv Syst Date: 2001-02 Impact factor: 1.475
Authors: Bizhan Aarabi; Dale C Hesdorffer; Edward S Ahn; Carla Aresco; Thomas M Scalea; Howard M Eisenberg Journal: J Neurosurg Date: 2006-04 Impact factor: 5.115
Authors: Michael F Stiefel; Gregory G Heuer; Michelle J Smith; Stephanie Bloom; Eileen Maloney-Wilensky; Vincente H Gracias; M Sean Grady; Peter D LeRoux Journal: J Neurosurg Date: 2004-08 Impact factor: 5.115