Decompressive craniectomy in paediatric traumatic brain injury: a systematic review of current evidence
File(s)ChildsNervSyst-DC-2018.pdf (665.17 KB)
Published version
Author(s)
Ardissino, Maddalena
Tang, Alice
Muttoni, Elisabetta
Tsang, Kevin
Type
Journal Article
Abstract
Introduction
Paediatric traumatic brain injury (pTBI) is one of the most frequent neurological presentations encountered in emergency departments worldwide. Every year, more than 200,000 American children suffer pTBIs, many of which lead to long-term damage.
Objectives
We aim to review the existing evidence on the efficacy of the decompressive craniectomy (DC) in controlling intracranial pressure (ICP) and improving long-term outcomes in children with pTBI.
Methods
A comprehensive search of the MEDLINE and EMBASE databases led to the screening of 212 studies, 12 of which satisfied inclusion criteria. Data extracted included the number and ages of patients, Glasgow Coma Scale scores at presentation, treatment protocols and short- and long-term outcomes.
Results
Each of the nine studies including ICP as an outcome reported that it was successfully controlled by DC. The 6–12 month outcome scores of patients undergoing DC were positive, or superior to those of medically treated groups in nine of 11 studies. Mortality was compared in only two studies, and was lower in the DC group in both.Very few studies are currently available investigating short- and long-term outcomes in children with TBI undergoing DC.
Conclusion
The currently available evidence may support a beneficial role of DC in controlling ICP and improving long-term outcomes.
Paediatric traumatic brain injury (pTBI) is one of the most frequent neurological presentations encountered in emergency departments worldwide. Every year, more than 200,000 American children suffer pTBIs, many of which lead to long-term damage.
Objectives
We aim to review the existing evidence on the efficacy of the decompressive craniectomy (DC) in controlling intracranial pressure (ICP) and improving long-term outcomes in children with pTBI.
Methods
A comprehensive search of the MEDLINE and EMBASE databases led to the screening of 212 studies, 12 of which satisfied inclusion criteria. Data extracted included the number and ages of patients, Glasgow Coma Scale scores at presentation, treatment protocols and short- and long-term outcomes.
Results
Each of the nine studies including ICP as an outcome reported that it was successfully controlled by DC. The 6–12 month outcome scores of patients undergoing DC were positive, or superior to those of medically treated groups in nine of 11 studies. Mortality was compared in only two studies, and was lower in the DC group in both.Very few studies are currently available investigating short- and long-term outcomes in children with TBI undergoing DC.
Conclusion
The currently available evidence may support a beneficial role of DC in controlling ICP and improving long-term outcomes.
Date Issued
2019-02-01
Date Acceptance
2018-09-05
Citation
CHILDS NERVOUS SYSTEM, 2019, 35 (2), pp.209-216
ISSN
0256-7040
Publisher
Springer
Start Page
209
End Page
216
Journal / Book Title
CHILDS NERVOUS SYSTEM
Volume
35
Issue
2
Copyright Statement
© The Author(s) 2018. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
License URL
Identifier
http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000457135900004&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=1ba7043ffcc86c417c072aa74d649202
Subjects
Science & Technology
Life Sciences & Biomedicine
Clinical Neurology
Pediatrics
Surgery
Neurosciences & Neurology
Paediatric traumatic brain injury
TBI
Decompressive craniectomy
Intracranial pressure
ICP
Outcomes
Management
REFRACTORY INTRACRANIAL HYPERTENSION
SINGLE-CENTER EXPERIENCE
CHILDREN
CRANIOTOMY
TRIAL
Publication Status
Published
Date Publish Online
2018-09-13