LONG-TERM PROGNOSTIC ANALYSIS OF EMERGENCY DECOMPRESSIVE CRANIECTOMY FOR SEVERE TRAUMATIC BRAIN INJURY PATIENTS WITH BILATERAL FIXED DILATED PUPILS AND GCS≤8: A PROSPECTIVE OBSERVATIONAL STUDY

Background: Severetraumatic brain injury (sTBI) remains a leading cause of morbidity and mortality worldwide, particularly in patients with bilateral xed dilated pupils (BFDP) and low Glasgow Coma Scale (GCS) score. This study evaluated the prognostic factors associated with outcomes in patients undergoing decompressive craniectomy (DC) for sTBI with FDP and GCS ≤8. Methods: This prospective observational study was performed over the period of 18-months (January 2023 to June 2024) and involved 80 sTBI patients with BFDP and a GCS score of ≤8. Following emergency DC,the patients were assessed at discharge, 6-months, and 12-months. Outcomes of interest included mortality and favorable outcome, assessed with the Glasgow Outcome Scale (GOS) score of 4–5. Results: During the study, the overall survival rates decreased from 41.25% to 25.00%, while the favorable outcome increased from 15.00% to 17.00%. At discharge, 6-months, and 12-months, the lower preoperative GCS (OR: 2.074, 2.039, and 2.093; p<0.0001, respectively) and higher preoperative Marshall score (OR: 0.580, 0.625, and 0.547;p<0.05,respectively) were signicant mortality predictors. Additionally, tracheostomy (OR: 6.380and 5.107;p<0.05, respectively) at discharge and 6-months, and male sex (OR: 3.037, p=0.034) at 6-months were signicant mortality predictors. At discharge, 6-months, and 12-months, lower preoperative GCS (OR: 3.749, 4.137, and 3.760; p<0.05, respectively) and higher preoperative Marshall score (OR: 0.566, 0.525, and 0.519;p<0.05, respectively) were signicant predictors of unfavorable outcome. Conclusion: Apart from BFDP, lower GCS scores and higher Marshall scores are critical preoperative prognostic factors of mortality and unfavorable outcomes in sTBI patients undergoing emergency DC.