Carla B Rynkowski1, Luciano Silveira Basso2, Angelos G Kolias3, Marino Muxfeldt Bianchin4. 1. Adult Critical Care Unit, Hospital Cristo Redentor, Porto Alegre, Brazil. carlarynkowski@gmail.com. 2. Department of Neurosurgery, Hospital Cristo Redentor, Porto Alegre, Brazil. 3. Neurosurgical Division, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK. 4. B.R.A.I.N., Division of Neurology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.
Abstract
BACKGROUND: Decompressive craniectomy (DC) may reduce mortality but might increase the number of survivors in a vegetative state. In this study, we assessed the long-term functional outcome of patients undergoing DC in a middle-income country. METHODS: This was a prospective observational study of patients undergoing DC at a single tertiary hospital in southern Brazil between January 2015 and December 2018. RESULTS: Of the 125 patients who were included in this study, 57.6% (72/125) had a traumatic brain injury (TBI), 21.6% (27/125) had a stroke, 19.2% (24/125) had a cerebral hemorrhage (intracerebral or subarachnoid hemorrhage), and 0.8% (1/125) had a cerebral abscess. The mean age was 45.18 ± 19.6 years, and 71% of the patients were men. The mean initial Glasgow Coma Scale (GCS) score was 7.8 ± 3.6. The in-hospital mortality rate was 44.8% (56/125). Of the survivors, 50.7% (35/69) had a favorable outcome 6 months after DC. After multivariate analysis, a lower initial GCS score (7.5 ± 3.6 versus 8.8 ± 3.5, P = 0.007) and older age (49.7 ± 18.9 versus 33.3 ± 16.2 years, P = 0.0001) were associated with an unfavorable outcome. CONCLUSION: Six months after DC, almost half of the patients who survive have a favorable outcome.
BACKGROUND: Decompressive craniectomy (DC) may reduce mortality but might increase the number of survivors in a vegetative state. In this study, we assessed the long-term functional outcome of patients undergoing DC in a middle-income country. METHODS: This was a prospective observational study of patients undergoing DC at a single tertiary hospital in southern Brazil between January 2015 and December 2018. RESULTS: Of the 125 patients who were included in this study, 57.6% (72/125) had a traumatic brain injury (TBI), 21.6% (27/125) had a stroke, 19.2% (24/125) had a cerebral hemorrhage (intracerebral or subarachnoid hemorrhage), and 0.8% (1/125) had a cerebral abscess. The mean age was 45.18 ± 19.6 years, and 71% of the patients were men. The mean initial Glasgow Coma Scale (GCS) score was 7.8 ± 3.6. The in-hospital mortality rate was 44.8% (56/125). Of the survivors, 50.7% (35/69) had a favorable outcome 6 months after DC. After multivariate analysis, a lower initial GCS score (7.5 ± 3.6 versus 8.8 ± 3.5, P = 0.007) and older age (49.7 ± 18.9 versus 33.3 ± 16.2 years, P = 0.0001) were associated with an unfavorable outcome. CONCLUSION: Six months after DC, almost half of the patients who survive have a favorable outcome.
Authors: Nancy Carney; Annette M Totten; Cindy O'Reilly; Jamie S Ullman; Gregory W J Hawryluk; Michael J Bell; Susan L Bratton; Randall Chesnut; Odette A Harris; Niranjan Kissoon; Andres M Rubiano; Lori Shutter; Robert C Tasker; Monica S Vavilala; Jack Wilberger; David W Wright; Jamshid Ghajar Journal: Neurosurgery Date: 2017-01-01 Impact factor: 4.654
Authors: Peter J Hutchinson; Angelos G Kolias; Tamara Tajsic; Amos Adeleye; Abenezer Tirsit Aklilu; Tedy Apriawan; Abdul Hafid Bajamal; Ernest J Barthélemy; B Indira Devi; Dhananjaya Bhat; Diederik Bulters; Randall Chesnut; Giuseppe Citerio; D Jamie Cooper; Marek Czosnyka; Idara Edem; Nasser M F El-Ghandour; Anthony Figaji; Kostas N Fountas; Clare Gallagher; Gregory W J Hawryluk; Corrado Iaccarino; Mathew Joseph; Tariq Khan; Tsegazeab Laeke; Oleg Levchenko; Baiyun Liu; Weiming Liu; Andrew Maas; Geoffrey T Manley; Paul Manson; Anna T Mazzeo; David K Menon; Daniel B Michael; Susanne Muehlschlegel; David O Okonkwo; Kee B Park; Jeffrey V Rosenfeld; Gail Rosseau; Andres M Rubiano; Hamisi K Shabani; Nino Stocchetti; Shelly D Timmons; Ivan Timofeev; Chris Uff; Jamie S Ullman; Alex Valadka; Vicknes Waran; Adam Wells; Mark H Wilson; Franco Servadei Journal: Acta Neurochir (Wien) Date: 2019-05-28 Impact factor: 2.216