The Role of Decompressive Craniectomy in Traumatic Brain Injury: An Institutional Experience in a Tertiary Care Hospital

Abstract:Background: Traumatic brain injury can damage the brain on permanent basis, to protect the brain Decompressive can play a pivot role to protect from secondary brain injury. Objective: To assess the prognosis and functional outcomes in role of decompressive craniectomy in traumatic brain injury in tertiary care hospital. Materials and Methods: This study conducted at Jinnah Post Graduate Medical Institute (JPMC) in Karachi from January 2018 to April 2022, comprises of 304 patients who underwent decompressive craniectomy following traumatic brain injury, specifically those with traumatic mass lesions. Our aim was to gain insight into their functional outcomes over a period of six months, utilizing the Glasgow Outcome Score at intervals of one month, three months, and six months, employing the chi-squared test, to identify any parameters that correlated with poor outcomes. This helped us discern potential factors contributing to unfavorable results. Result: The current study comprised 304 individuals, with a median age of 48 years (IQR: 43-53). The majority of patients (66.1%) were older than 45 years. The median time since injury was 10 hours (IQR: 7-13.75). The median GCS score was (IQR: 5-7). The majority of patients had ASDH + Contusion (44.1%) and ASDH (42.1%) on CT scans. In our study, 38.5% of patients had a good outcome, whereas 61.5% had a poor outcome. The outcome was significantly associated with gender (p=0.033), age group (p <0.001), time since injury (p<0.001), GCS score (p<0.001), midline shift (p<0.001), mass lesion volume (p<0.001), and CT findings (p=0.002). Conclusion: Decompressive craniectomy stands as a pivotal intervention in the management of severe traumatic brain injury (sTBI) patients grappling with traumatic mass lesions.