Thirty-day mortality in traumatically brain-injured patients undergoing decompressive craniectomy

Clinical article

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Object

Decompressive craniectomy is a life-saving measure for patients who have sustained traumatic brain injury (TBI), but patients undergoing this procedure may still die during an early phase of head injury. The aim of this study was to investigate the incidence, causes, and risk factors of 30-day mortality in traumatically brain-injured patients undergoing decompressive craniectomy.

Methods

The authors included 201 head-injured patients undergoing decompressive craniectomy in this 3-year retrospective study. The main outcome evaluated was 30-day mortality in patients who had undergone craniectomy after TBI. Demographic and clinical data, including information on death, were obtained for subsequent analysis. The authors identified differences between survivors and nonsurvivors in terms of clinical parameters; multivariate logistic regression was used to adjust for independent risk factors of short-term death.

Results

The 30-day mortality rate was 26.4% in traumatically brain-injured patients undergoing decompressive craniectomy. The majority of deaths following decompression resulted from uncontrollable brain swelling and extensive brain infarction, which accounted for 79.2% of mortality. In the multivariate logistic regression mode, the 2 independent risk factors for 30-day mortality were age (OR 1.035 [95% CI 1.006–1.064]; p = 0.018) and Glasgow Coma Scale (GCS) score before decompressive craniectomy (OR 0.769 [95% CI 0.597–0.990]; p = 0.041).

Conclusions

There is a high 30-day mortality rate in traumatically brain-injured patients undergoing decompressive craniectomy. Most of the deaths are attributed to ongoing brain damage, even after decompression. Risk factors of short-term death, including age and preoperative GCS score, are important in patient selection for decompressive craniectomy, and these factors should be considered together to ensure the highest chance of surviving TBI.

Abbreviations used in this paper:GCS = Glasgow Coma Scale; ISS = Injury Severity Score; TBI = traumatic brain injury.

Article Information

Address correspondence to: Aij-Lie Kwan, M.D., Department of Neurosurgery, Kaohsiung Medical University Hospital, No. 100, Tzyou 1st Road, Sham-min District, Kaohsiung City 807, Taiwan, Republic of China. email: a_lkwan@yahoo.com.

Please include this information when citing this paper: published online March 8, 2013; DOI: 10.3171/2013.1.JNS121775.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Distributions of time to mortality. Group A includes patients with brain swelling and brain infarction; Group B, those with delayed intraaxial and extraaxial hemorrhage; and Group C, those with medical morbidity-related deaths. Error bars show 95% CIs.

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    Kaplan-Meier survival curves for traumatically brain-injured patients undergoing decompressive craniectomy according to age group (p = 0.028, log-rank test).

  • View in gallery

    Kaplan-Meier survival curves for traumatically brain-injured patients undergoing decompressive craniectomy according to GCS group (p < 0.001, log-rank test).

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