Outcomes of Decompressive Craniectomy in Extremely Severe Traumatic Brain Injury (GCS-P ≤3): A Retrospective Audit

Abstract

A Glasgow coma scale (GCS) score of 3 is associated with very high mortality and morbidity in patients with head injury. The new GCS-P scale is an extended index of severity with an unfavorable outcome rate of 90% at GCS-P 1. There are conflicting reports in literature regarding the efficacy of decompressive craniectomy (DC) in severe head injury with very low GCS.

The aim of the study is to audit the outcome of DC for the patients with the most severe head injury with GCS-P score of 3 and less.

A retrospective observational audit was conducted of patients who were admitted with severe traumatic brain injury, a GCS-P score of 1, 2, and 3, intracranial bleed, and severe edema on CT. The option of surgery was offered according to the choice of the relatives after explaining the poor prognosis and based on the patient's hemodynamic stability. The patients were grouped into those who underwent DC and those who did not. Survival and Glasgow Outcome Scale (GOS) scores were assessed in those who survived.

Twelve patients survived after DC out of 48 (12/48, 25%). No patient survived in the conservative group: (0/22, 0%). The standard error (SE) of the difference between the proportions of survival was statistically significant. Six patients (6/48, 12.5%) had a good functional outcome with GOS scores of 4 and 5.

The results of this audit show that DC was associated with survival in a subset of patients with GCS-P ≤3, whereas no survival was observed in the conservatively managed cohort.