Page 44 - DECISION-MAKING IN SEVERE TRAUMATIC BRAIN INJURY PATIENT OUTCOME, HOSPITAL COSTS, AND RESEARCH PRACTICE

Chapter 2
Tabel II continued
Study information
Li (2008)35 China, 2001-2006 Retrospective
Gouello (2014)36 France, 2005-2011 Retrospective
Aarabi (2006)37 USA, 2000-2004 Retrospective
Pompucci (2007)38
Italy, 1994-2004 Retrospective
Akyuz (2010)39 Turkey, 2003-2008 Retrospective
Yuan (2013)40 China, 2005-2009 Comparative
Limpastan (2013)41 Thailand 2006-2008 Retrospective
Csokay (2001)42 Hungary, 1998-2000 Retrospective comparative
Purpose
Compare large DC (LDC) with
routine DC (RDC) in s-TBI patients
Outcome of DC in s-TBI patients
DC in TBI (malignant brain swelling)
Effect of DC.
Effectiveness of early bilateral DC in s-TBI patients
Difference between DC with and without mass evacuation
in TBI
Evaluate risk factors influencing outcome after DC in s-TBI
Evaluation of new operative technique: vascular tunnelling (VT).
Population
N=263 LDC: 135 -GCS3-5: 54 RDC: 138 -GCS3-5: 49
N= 60 GCS3-5: 26 Primary: 20 Secondary: 40
N=50 GCS3-5: 15 BS: 88%
N=55 GCS3-5: 31 No focal lesion: 38% ASDH+ BE: 62%
N=76 GCS4+5: 20
1: Second-
tier DC: 36
2: First-tier: 40
N=164 GCS3-5: 51 2 groups.
N=159 GCS3-5: 63
N=20 (19TBI) All GCS<6, BE. 1: VT: 20
2: Previous cohort: 20
♂ Age
69 ±47
77 33 66 25 63 53
59 1:37.6 2:41.3
75 48
82 36
NP NP
Type of GCS score
Administration
Initial management
Post- resuscitation
Post- resuscitation
Initial
Admission
Preoperative
NP
Pupils
Bilateral DP:38 Unilateral DP: 97
CSP:43% UnilateralDP:57% Bilateral DP:22% ACR:8%
ALR:22% NP
NP
ALR:
1: 56% 2: 48%
80.3% of deceased group had no pupillary light reflex
Bilateral DP: 20% Unilateral DP: 35%
Table II: Abbreviations: ♂: Male; ACR; Absent Corneal Reflex; ALR; Abnormal Light Response; ANI: Anisocoria; ASDH: Acute Subdural Hematoma; BE: Brain Edema; BFDP: Bilateral Fixed Dilated Pupils; BS: Brain Swelling; CC: Cerebral Contusion; CSP: Constricted Symmetrical Pupils; DC: Decompressive Craniectomy; DP: Dilated Pupil(s); EDH: Epidural Hematoma, FP: Fixed Pupil; FTPC: Frontotemporoparietal Craniectomy; GCS: Glasgow Coma Scale; GOS(E): Glasgow Outcome Scale (Extended); ICH: Intracranial Hypertension; ICP: Intracranial Pressure; IP: Intraparanchymal; LTFU: Loss to Follow Up; mRS: modified Rankin Scale; NP: Not Provided; s-TBI: severe Traumatic Brain Injury; TBI: Traumatic Brain Injury; TSAH: Traumatic Subarachnoid Hemorrhage; UFDP: Unilateral Fixed Dilated Pupil.
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