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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Decompressive craniectomy in diffuse traumatic brain injury
New England Journal of Medicine, Volume 364, No. 16, Year 2011
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Description
Background: It is unclear whether decompressive craniectomy improves the functional outcome in patients with severe traumatic brain injury and refractory raised intracranial pressure. Methods: From December 2002 through April 2010, we randomly assigned 155 adults with severe diffuse traumatic brain injury and intracranial hypertension that was refractory to first-tier therapies to undergo either bifrontotemporoparietal decompressive craniectomy or standard care. The original primary outcome was an unfavorable outcome (a composite of death, vegetative state, or severe disability), as evaluated on the Extended Glasgow Outcome Scale 6 months after the injury. The final primary outcome was the score on the Extended Glasgow Outcome Scale at 6 months. Results: Patients in the craniectomy group, as compared with those in the standard-care group, had less time with intracranial pressures above the treatment threshold (P<0.001), fewer interventions for increased intracranial pressure (P<0.02 for all comparisons), and fewer days in the intensive care unit (ICU) (P<0.001). However, patients undergoing craniectomy had worse scores on the Extended Glasgow Outcome Scale than those receiving standard care (odds ratio for a worse score in the craniectomy group, 1.84; 95% confidence interval [CI], 1.05 to 3.24; P = 0.03) and a greater risk of an unfavorable outcome (odds ratio, 2.21; 95% CI, 1.14 to 4.26; P = 0.02). Rates of death at 6 months were similar in the craniectomy group (19%) and the standard-care group (18%). Conclusions: In adults with severe diffuse traumatic brain injury and refractory intracranial hypertension, early bifrontotemporoparietal decompressive craniectomy decreased intracranial pressure and the length of stay in the ICU but was associated with more unfavorable outcomes. (Funded by the National Health and Medical Research Council of Australia and others; DECRA Australian Clinical Trials Registry number, ACTRN012605000009617.) Copyright © 2011 Massachusetts Medical Society.
Authors & Co-Authors
Cooper, D. James
Australia, Clayton
Monash University
Rosenfeld, Jeffrey V.
Australia, Clayton
Monash University
Murray, Lynnette J.
Australia, Clayton
Monash University
Arabi, Yaseen M.
Saudi Arabia, Riyadh
King Saud Bin Abdulaziz University for Health Sciences
Davies, Andrew R.
Australia, Clayton
Monash University
D'Urso, Paul
Australia, Melbourne
Neurosciences
Kossmann, Thomas
Australia, Melbourne
Epworth Healthcare
Ponsford, Jennie L.
Australia, Clayton
Monash University
Australia, Melbourne
Monash-epworth Rehabilitation Research Centre
Seppelt, Ian
Australia, Sydney
The University of Sydney
Reilly, Peter Lawrence
Australia, Adelaide
Royal Adelaide Hospital
Wolfe, Rory S.J.
Australia, Clayton
Monash University
Statistics
Citations: 1,191
Authors: 11
Affiliations: 7
Identifiers
Doi:
10.1056/NEJMoa1102077
ISSN:
00284793
e-ISSN:
15334406
Research Areas
Disability
Noncommunicable Diseases
Violence And Injury
Study Design
Case-Control Study