Lee Jan Hau, MBBS, MRCPCH, MCI (he/him/his)
KK Women's and Children's Hospital, Singapore
Singapore, Slovenia
Disclosure information not submitted.
Hongxing Dang, MD
Dr
Children’s Hospital of Chongqing Medical University, United States
Disclosure information not submitted.
Sharon Yin Yee Low, MBBS, PhD, FRCS, GDPM
Assistant Professor
KK Women's and Children's Hospital, Singapore
Disclosure information not submitted.
Dianna Sri Dewi, BSc
Clinical Research Coordinator
KK Women's and Children's Hospital, Singapore
Disclosure information not submitted.
Shu-Ling Chong, MBBS, MRCPCH, MCI, MPH
Clinical Associate Professor
KK Women's and Children's Hospital, Singapore
Disclosure information not submitted.
Title: Decompressive Craniectomy in Pediatric Traumatic Brain Injury: a Dual-Center Retrospective Study
Introduction: Decompressive craniectomy (DC) in children with severe traumatic brain injury (TBI) and raised intracranial pressure (ICP) refractory to medical treatment remains controversial. This study aims to (1) describe the characteristics of children with moderate to severe TBI who underwent DC and (2) compare post-treatment outcomes between children undergoing DC versus medical therapy.
Methods: We described children (< 16 years) who underwent DC in 2 pediatric centers in Singapore and Chongqing, China within 24 hours of head injury between January 2014 and October 2017. Functional outcomes were measured at discharge using the Pediatric Cerebral Performance Category. Poor outcomes were defined as moderate, severe disability, vegetative or comatose state at discharge, or mortality. Each child who underwent DC was matched 1:1 to a child who did not undergo DC, based on the same GCS and +/- 2 years of age.
Results: Among 18 children who underwent DC, median (IQR) age and GCS were 4.0 (1.0,9.5) years and 7.0 (3.0,9.0) respectively. The most common mechanisms of injury were falls (44.4%), child abuse (27.8%) and traffic accidents (22.2%). Median time from injury to surgery was 7.57 (3.83,10.78) hours. 16 patients (88.9%) underwent unilateral DC and 94.4% had supratentorial removal of bone flap. The median post-operative ICP decreased from 27 (19,50) mmHg at 12 hours to 20 (16.50,27.50) mmHg at 72 hours. 14 patients (77.8%) had poor outcomes, including 3 deaths. The most common post-operative complication was intracerebral hematoma (22.2%). Compared to medically treated patients, DC patients had poorer functional outcomes (77.8% vs 27.8%, p=0.003), shorter median 14-day ICU-free (2.50 (0.00,5.75) vs 9.00 (0.00,12.00), p=0.040) and 28-day hospital-free days (0.00 (0.00,3.50) vs 14.00 (0.00,23.00), p=0.006). There was no difference in mortality (16.6% vs 22.2%, p=0.674) or median 14-day mechanical ventilation-free days (6.50 (0.00,12.25) vs 11.50 (3.75,13.00), p=0.104) between the two groups.
Conclusions: Children who underwent DC are at risk of poor functional outcomes (77.8%) and mortality (16.7%). When compared to children who underwent medical therapy, children with DC had a longer duration of ICU and hospital stay, as well as poorer functional outcomes, but similar mortality and length of mechanical ventilation.