1128 Outcomes of Early and Late Decompressive Craniectomies in Contrast to Standard Medical Management in Patients with Traumatic Brain Injury with Refractory Intracranial Hypertension: Systematic Review and Meta-Analysis Study
K Minta, C Kaliaperumal, T Shaker- Surgery
Abstract
Aim
The meta-analysis explored the effectiveness of early and late decompressive craniectomies versus medical management in patients with refractory intracranial hypertension after sustaining traumatic brain injury. The clinical outcomes analysed were grouped into 2 categories: favourable (good recovery and moderate disability) and unfavourable outcomes (death, vegetative state, and severe disability). Intracranial pressure has been measured post-randomisation in the studies included.
Method
Google Scholar, Cochrane and Medline search engines were utilised for data collection ranging from 1999 until present. The searched keywords encompassed: decompressive craniectomy, refractory intracranial hypertension, medical management, and traumatic brain injury. Thereafter, the data was uploaded to Review Manager for statistical analysis.
Results
Of the 122 articles, 10 randomized controlled trials were included in the meta-analysis. The analysis yielded that relative risk (RR) of overall mortality in decompressive craniectomy group vs medical management is 0.58 95% CI [0.41, 0.81] (P = 0.001). The standardised mean difference (SMD) for intracranial pressure is -2.59 95% CI [-3.72, -1.46] (P < 0.00001) between the two groups. The odds ratio considering favourable outcomes (Glasgow Outcome Scale) for patients undergoing surgery vs medical care is 1.02 95% [0.57, 1.82] (P = 0.95).
Conclusions
This meta-analysis demonstrates that decompressive craniectomy significantly reduces the overall mortality and intracranial pressure in patients with TBI and refractory intracranial hypertension versus medical management. Decompressive craniectomy has a greater potential to treat TBI patients with refractory intracranial hypertension than medical care alone however more randomised clinical trials are needed to ascertain the effectiveness of the superiority of these treatments in the future research.