Decompressive craniectomy versus craniotomy only for intracranial hemorrhage evacuation

A propensity matched study

Faisal Jehan, Asad Azim, Peter Rhee, Muhammad Khan, Lynn Gries, Terence OKeeffe, Narong Kulvatunyou, Andrew Tang, Bellal Joseph

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

BACKGROUND Decompressive craniectomy (DC) is often performed in conjunction with evacuation of intracranial hemorrhage (ICH) to control intracranial pressure (ICP) in patients with a traumatic brain injury (TBI). The efficacy of DC in lowering ICP is well established; however, its effect on clinical outcomes remains controversial. The aim of our study is to assess outcomes in TBI patients undergoing DC versus craniotomy only (CO) for the evacuation of ICH. METHODS We performed a 5-year retrospective analysis of TBI patients with ICH who underwent craniotomy or craniectomy for traumatic ICH. Patients were divided into two groups, those who underwent CO and those who underwent DC. Propensity scoring matched patients in a 1:2 ratio for demographics, admission Glasgow Coma Scale (GCS) score, severity of injury, type and size of ICH, and anticoagulant use. Outcome measures included mortality, adverse discharge disposition (skilled nursing facility), discharge GCS and Glasgow Outcome Scale scores, and complications. RESULTS We reviewed 1,831 patients with TBI, of which 155 underwent craniotomy and/or craniectomy. After propensity score matching, we included 99 of those patients in our study (DC, 33; CO, 66). Matched groups were similar in age (p = 0.68), admission GCS score (p = 0.50), Injury Severity Score (p = 0.70), head Abbreviated Injury Scale score (p = 0.32), and intracranial bleeding characteristics. Overall, 26.3% (n = 26) of the patients died and 62.6% (n = 62) were discharged to Rehab/skilled nursing facility. There was no difference in the mortality rate (27.3% vs. 25.0%; p = 0.99), adverse discharge disposition (45% vs. 33%; p = 0.66), GCS score (p = 0.53), and Glasgow Outcome Scale (p = 0.80) at discharge between the DC and the CO groups. However, patients in DC group had higher complication rates and ventilator days. CONCLUSION This study showed no significant difference in clinical outcomes for patients undergoing evacuation of ICH regardless of the procedure performed. DC did not appear to be superior to craniotomy alone for the treatment of acute ICH. LEVEL OF EVIDENCE Therapeutic, level III.

Original languageEnglish (US)
Pages (from-to)1148-1153
Number of pages6
JournalJournal of Trauma and Acute Care Surgery
Volume83
Issue number6
DOIs
StatePublished - Dec 1 2017
Externally publishedYes

Fingerprint

Decompressive Craniectomy
Intracranial Hemorrhages
Craniotomy
Glasgow Coma Scale
Skilled Nursing Facilities
Glasgow Outcome Scale
Injury Severity Score
Intracranial Pressure
Traumatic Intracranial Hemorrhage
Abbreviated Injury Scale
Propensity Score
Mortality
Mechanical Ventilators
Craniocerebral Trauma
Anticoagulants
Research Design

Keywords

  • craniotomy
  • Decompressive craniectomy
  • intracranial hemorrhage evacuation
  • TBI

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

Decompressive craniectomy versus craniotomy only for intracranial hemorrhage evacuation : A propensity matched study. / Jehan, Faisal; Azim, Asad; Rhee, Peter; Khan, Muhammad; Gries, Lynn; OKeeffe, Terence; Kulvatunyou, Narong; Tang, Andrew; Joseph, Bellal.

In: Journal of Trauma and Acute Care Surgery, Vol. 83, No. 6, 01.12.2017, p. 1148-1153.

Research output: Contribution to journalArticle

Jehan, Faisal ; Azim, Asad ; Rhee, Peter ; Khan, Muhammad ; Gries, Lynn ; OKeeffe, Terence ; Kulvatunyou, Narong ; Tang, Andrew ; Joseph, Bellal. / Decompressive craniectomy versus craniotomy only for intracranial hemorrhage evacuation : A propensity matched study. In: Journal of Trauma and Acute Care Surgery. 2017 ; Vol. 83, No. 6. pp. 1148-1153.
@article{aceaf59579fc41ff8c1655dd3bb0d9ef,
title = "Decompressive craniectomy versus craniotomy only for intracranial hemorrhage evacuation: A propensity matched study",
abstract = "BACKGROUND Decompressive craniectomy (DC) is often performed in conjunction with evacuation of intracranial hemorrhage (ICH) to control intracranial pressure (ICP) in patients with a traumatic brain injury (TBI). The efficacy of DC in lowering ICP is well established; however, its effect on clinical outcomes remains controversial. The aim of our study is to assess outcomes in TBI patients undergoing DC versus craniotomy only (CO) for the evacuation of ICH. METHODS We performed a 5-year retrospective analysis of TBI patients with ICH who underwent craniotomy or craniectomy for traumatic ICH. Patients were divided into two groups, those who underwent CO and those who underwent DC. Propensity scoring matched patients in a 1:2 ratio for demographics, admission Glasgow Coma Scale (GCS) score, severity of injury, type and size of ICH, and anticoagulant use. Outcome measures included mortality, adverse discharge disposition (skilled nursing facility), discharge GCS and Glasgow Outcome Scale scores, and complications. RESULTS We reviewed 1,831 patients with TBI, of which 155 underwent craniotomy and/or craniectomy. After propensity score matching, we included 99 of those patients in our study (DC, 33; CO, 66). Matched groups were similar in age (p = 0.68), admission GCS score (p = 0.50), Injury Severity Score (p = 0.70), head Abbreviated Injury Scale score (p = 0.32), and intracranial bleeding characteristics. Overall, 26.3{\%} (n = 26) of the patients died and 62.6{\%} (n = 62) were discharged to Rehab/skilled nursing facility. There was no difference in the mortality rate (27.3{\%} vs. 25.0{\%}; p = 0.99), adverse discharge disposition (45{\%} vs. 33{\%}; p = 0.66), GCS score (p = 0.53), and Glasgow Outcome Scale (p = 0.80) at discharge between the DC and the CO groups. However, patients in DC group had higher complication rates and ventilator days. CONCLUSION This study showed no significant difference in clinical outcomes for patients undergoing evacuation of ICH regardless of the procedure performed. DC did not appear to be superior to craniotomy alone for the treatment of acute ICH. LEVEL OF EVIDENCE Therapeutic, level III.",
keywords = "craniotomy, Decompressive craniectomy, intracranial hemorrhage evacuation, TBI",
author = "Faisal Jehan and Asad Azim and Peter Rhee and Muhammad Khan and Lynn Gries and Terence OKeeffe and Narong Kulvatunyou and Andrew Tang and Bellal Joseph",
year = "2017",
month = "12",
day = "1",
doi = "10.1097/TA.0000000000001658",
language = "English (US)",
volume = "83",
pages = "1148--1153",
journal = "Journal of Trauma and Acute Care Surgery",
issn = "2163-0755",
publisher = "Lippincott Williams and Wilkins",
number = "6",

}

TY - JOUR

T1 - Decompressive craniectomy versus craniotomy only for intracranial hemorrhage evacuation

T2 - A propensity matched study

AU - Jehan, Faisal

AU - Azim, Asad

AU - Rhee, Peter

AU - Khan, Muhammad

AU - Gries, Lynn

AU - OKeeffe, Terence

AU - Kulvatunyou, Narong

AU - Tang, Andrew

AU - Joseph, Bellal

PY - 2017/12/1

Y1 - 2017/12/1

N2 - BACKGROUND Decompressive craniectomy (DC) is often performed in conjunction with evacuation of intracranial hemorrhage (ICH) to control intracranial pressure (ICP) in patients with a traumatic brain injury (TBI). The efficacy of DC in lowering ICP is well established; however, its effect on clinical outcomes remains controversial. The aim of our study is to assess outcomes in TBI patients undergoing DC versus craniotomy only (CO) for the evacuation of ICH. METHODS We performed a 5-year retrospective analysis of TBI patients with ICH who underwent craniotomy or craniectomy for traumatic ICH. Patients were divided into two groups, those who underwent CO and those who underwent DC. Propensity scoring matched patients in a 1:2 ratio for demographics, admission Glasgow Coma Scale (GCS) score, severity of injury, type and size of ICH, and anticoagulant use. Outcome measures included mortality, adverse discharge disposition (skilled nursing facility), discharge GCS and Glasgow Outcome Scale scores, and complications. RESULTS We reviewed 1,831 patients with TBI, of which 155 underwent craniotomy and/or craniectomy. After propensity score matching, we included 99 of those patients in our study (DC, 33; CO, 66). Matched groups were similar in age (p = 0.68), admission GCS score (p = 0.50), Injury Severity Score (p = 0.70), head Abbreviated Injury Scale score (p = 0.32), and intracranial bleeding characteristics. Overall, 26.3% (n = 26) of the patients died and 62.6% (n = 62) were discharged to Rehab/skilled nursing facility. There was no difference in the mortality rate (27.3% vs. 25.0%; p = 0.99), adverse discharge disposition (45% vs. 33%; p = 0.66), GCS score (p = 0.53), and Glasgow Outcome Scale (p = 0.80) at discharge between the DC and the CO groups. However, patients in DC group had higher complication rates and ventilator days. CONCLUSION This study showed no significant difference in clinical outcomes for patients undergoing evacuation of ICH regardless of the procedure performed. DC did not appear to be superior to craniotomy alone for the treatment of acute ICH. LEVEL OF EVIDENCE Therapeutic, level III.

AB - BACKGROUND Decompressive craniectomy (DC) is often performed in conjunction with evacuation of intracranial hemorrhage (ICH) to control intracranial pressure (ICP) in patients with a traumatic brain injury (TBI). The efficacy of DC in lowering ICP is well established; however, its effect on clinical outcomes remains controversial. The aim of our study is to assess outcomes in TBI patients undergoing DC versus craniotomy only (CO) for the evacuation of ICH. METHODS We performed a 5-year retrospective analysis of TBI patients with ICH who underwent craniotomy or craniectomy for traumatic ICH. Patients were divided into two groups, those who underwent CO and those who underwent DC. Propensity scoring matched patients in a 1:2 ratio for demographics, admission Glasgow Coma Scale (GCS) score, severity of injury, type and size of ICH, and anticoagulant use. Outcome measures included mortality, adverse discharge disposition (skilled nursing facility), discharge GCS and Glasgow Outcome Scale scores, and complications. RESULTS We reviewed 1,831 patients with TBI, of which 155 underwent craniotomy and/or craniectomy. After propensity score matching, we included 99 of those patients in our study (DC, 33; CO, 66). Matched groups were similar in age (p = 0.68), admission GCS score (p = 0.50), Injury Severity Score (p = 0.70), head Abbreviated Injury Scale score (p = 0.32), and intracranial bleeding characteristics. Overall, 26.3% (n = 26) of the patients died and 62.6% (n = 62) were discharged to Rehab/skilled nursing facility. There was no difference in the mortality rate (27.3% vs. 25.0%; p = 0.99), adverse discharge disposition (45% vs. 33%; p = 0.66), GCS score (p = 0.53), and Glasgow Outcome Scale (p = 0.80) at discharge between the DC and the CO groups. However, patients in DC group had higher complication rates and ventilator days. CONCLUSION This study showed no significant difference in clinical outcomes for patients undergoing evacuation of ICH regardless of the procedure performed. DC did not appear to be superior to craniotomy alone for the treatment of acute ICH. LEVEL OF EVIDENCE Therapeutic, level III.

KW - craniotomy

KW - Decompressive craniectomy

KW - intracranial hemorrhage evacuation

KW - TBI

UR - http://www.scopus.com/inward/record.url?scp=85024386829&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85024386829&partnerID=8YFLogxK

U2 - 10.1097/TA.0000000000001658

DO - 10.1097/TA.0000000000001658

M3 - Article

VL - 83

SP - 1148

EP - 1153

JO - Journal of Trauma and Acute Care Surgery

JF - Journal of Trauma and Acute Care Surgery

SN - 2163-0755

IS - 6

ER -