The Decompressive Craniectomy in Diffuse Traumatic Brain Injury or DECRA trial was the first neurosurgical randomized controlled trail that sought to answer whether decompressive craniectomies (DC) improved patient outcomes after severe diffuse traumatic brain injury (TBI). The trial was conducted over a decade in centers across New Zealand, Saudi Arabia, and Australia, and the results were published in 2011; 155 patients were randomized to two cohorts, the medical management cohort and the medical management plus DC cohort. The primary endpoint was the functional outcomes, measured at 6 months post discharge. The results of the trial were somewhat unanticipated. In spite of achieving superior ICP control and intensive care outcomes, the DC cohort had worse long-term outcomes. The DECRA trial raised several questions and criticisms that currently preclude us from drawing broad conclusions about the efficacy of DC in diffuse TBI.
Medical Management of Patients with Traumatic Brain Injury
