scholarly journals Mortality and outcomes after decompressive craniectomy in children with severe traumatic brain injury

2021 ◽  
Author(s):  
Nora Bruns ◽  
Oliver Kamp ◽  
Kim Melanie Lange ◽  
Rolf Lefering ◽  
Ursula Felderhoff-Mueser ◽  
...  
Keyword(s):  
Head Trauma ◽  
Decompressive Craniectomy ◽  
Medical Management ◽  
Odds Ratio ◽  
Severe Head Trauma ◽  
Negative Effects ◽  
High Quality ◽  
Poor Outcome ◽  
Multivariable Analyses ◽  
Poor Outcomes

Purpose: The effect of decompressive craniectomy (DC) on mortality and outcomes in children with elevated intracranial pressure after severe head trauma is strongly debated and high-quality evidence is lacking. This study was conducted to determine whether DC in children with severe head trauma is associated with a decrease in mortality or poor outcomes at discharge from the intensive care unit. Methods: Data on patients < 18 years of age treated in Germany, Austria, and Switzerland during a ten-year period were extracted from TraumaRegister DGU®, forming a retrospective multi-centre cohort study. Descriptive and multivariable analyses were performed to compare mortality and outcomes after decompressive craniectomy and medical management. Results: 2507 patients were included, of which 402 underwent decompressive craniectomy. Mortality was 20.6 % in children undergoing DC compared to 13.7 % after medical management. Observed and predicted mortality after DC and medical management matched in all subgroups except in children between six and 17 years of age, where mortality after DC was lower than predicted. Poor outcome was observed in 27.6 % of DC patients vs. 16.1 % receiving medical management. Logistic regression revealed slightly negative effects of DC on mortality (odds ratio 1.20, not significant) and outcomes (odds ratio 1.56 (95% confidence interval 1.01-2.40). Conclusion: DC did not decrease overall mortality or rates of poor outcome. However, children above six years of age may benefit from DC. High quality prospective studies are urgently needed.

scholarly journals Neutrophil to Lymphocyte Ratio Predicts Outcome of Stroke by Cervicocranial Arterial Dissection

2020 ◽  
Vol 7 ◽  
Author(s):  
Guangbi Sun ◽  
Yi Yang ◽  
Zhiguo Chen ◽  
Le Yang ◽  
Shanshan Diao ◽  
...  
Keyword(s):  
Predictive Value ◽  
Inflammatory Marker ◽  
Area Under The Curve ◽  
Neutrophil To Lymphocyte Ratio ◽  
Arterial Dissection ◽  
Lymphocyte Ratio ◽  
Poor Outcome ◽  
The Poor ◽  
Multivariable Analyses ◽  
Poor Outcomes

Background and Purpose: Neutrophil to lymphocyte ratio (NLR) is positively associated with poor prognosis in patients with cerebral infarction. The goal of this prospective study is to explore the predictive value of NLR in patients with acute ischemic stroke (AIS) caused by cervicocranial arterial dissection (CCAD).Methods: Ninety-nine patients with AIS caused by CCAD met criteria for inclusion and exclusion were selected for this study. We collected baseline data on the admission including NLR. The primary poor outcome was major disability (modified Rankin Scale score ≥ 3) or death at 3 months after AIS.Results: A total of 20 (20.2%) patients had a poor outcome at 3 months after AIS. According to the 3-month outcome, the patients were divided into two groups and univariate and multivariable analyses were conducted. Among the risk factors, elevated NLR levels were independently associated with 3-month poor outcomes. Further, we made the ROC curve to evaluate the predictive value of NLR level on prognosis. The area under the curve was 0.79 and a cut-off value of NLR was 2.97 for differentiating the poor outcome. We divided patients into groups according to the cut-off value. Patients with high NLR have a higher risk of poor outcome than those with low NLR (P &lt; 0.05).Conclusion: As an inflammatory marker, elevated NLR levels were associated with 3-month poor outcome in AIS caused by CCAD.

Use of Decompressive Craniectomy After Severe Head Trauma

AORN Journal ◽  
1999 ◽  
Vol 69 (3) ◽  
pp. 517-529 ◽  
Author(s):  
Jane Wick ◽  
James Wade ◽  
Daniel Rohrer ◽  
Oisin O'Neill
Keyword(s):  
Head Trauma ◽  
Decompressive Craniectomy ◽  
Severe Head Trauma

Contralateral haematoma secondary to decompressive craniectomy performed for severe head trauma: A descriptive study of 15 cases

Brain Injury ◽  
2013 ◽  
Vol 27 (3) ◽  
pp. 286-292 ◽  
Author(s):  
Liang Wen ◽  
Quan-Cheng Li ◽  
Shu-Chao Wang ◽  
Yu Lin ◽  
Gu Li ◽  
...  
Keyword(s):  
Head Trauma ◽  
Decompressive Craniectomy ◽  
Descriptive Study ◽  
Severe Head Trauma

scholarly journals Successful Decompressive Craniectomy in a Child with Severe Head Trauma

2018 ◽  
Vol 5 (1) ◽  
pp. 31-34
Author(s):  
Gökçen Özçifçi ◽  
Ayşe Berna Anıl ◽  
Neslihan Zengin ◽  
Fulya Kamit Can ◽  
Dilek Arslan ◽  
...  
Keyword(s):  
Head Trauma ◽  
Decompressive Craniectomy ◽  
Severe Head Trauma

scholarly journals Development and Clinical Translation of a Perioperative Nomogram Incorporating Free Fatty Acids to Predict Poor Outcome of Aneurysmal Subarachnoid Hemorrhage Following Endovascular Treatment

2021 ◽  
Vol 12 ◽  
Author(s):  
Yongyi Wang ◽  
Yongfan Xie ◽  
Houzhong Wang ◽  
Jifang Zhang ◽  
Chuanfeng Li ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Clinical Application ◽  
Endovascular Therapy ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Clinical Impact ◽  
Poor Outcome ◽  
Number Of Patients ◽  
Multivariable Analyses ◽  
Poor Outcomes ◽  
Individualized Prediction

Objective: A reliable prediction of clinical outcome is important for clinicians to set appropriate medical strategies in treating patients with aneurysmal subarachnoid hemorrhage (aSAH). In this study, we aim to establish a perioperative nomogram involving serum lipid signatures for predicting poor outcomes at 3 months in patients with aSAH following endovascular therapy.Methods: Data of patients with aSAH receiving endovascular therapy were collected. Univariable and multivariable analyses were performed to screen independent predictors related to unfavorable outcomes defined by the modified Rankin Scale (mFS) ≥3. A novel nomogram based on these significant features was conducted. The clinical application of this nomogram was assessed by decision curve analysis (DCA) and clinical impact curve.Results: A total number of patients included in this study were 213 (average age 58.9 years, 65.7% female), representing a poor 3-month outcome rate of 48.8%. Free fatty acid (FFA) levels on admission were efficient in predicting poor outcomes compared with other contents in serum lipids. Univariable and multivariable analyses revealed advanced age (P = 0.034), poor Hunt Hess (HH) (odds ratio, OR = 3.7, P &lt; 0.001) and mFS (OR = 6.0, P &lt; 0.001), aneurysms in the posterior circulation (OR = 4.4, P = 0.019), and higher FFA levels on admission (OR = 3.1, P = 0.021) were negative independent predictors of poor 3 months outcome. A novel nomogram composed of these significant features presented a concordance index (C-index) of 0.831 while the practical benefit was validated by DCA and clinical impact curve. An online calculator based on R programming promoted the clinical application of this nomogram.Conclusion: Nomogram involving age, HH grade, mFS, aneurysm location, and serum FFA levels was sufficient to provide an individualized prediction of 3-month poor outcome for each patient with aSAH who underwent endovascular therapy.

scholarly journals Decompressive Craniectomy in Pediatric Severe Head Trauma

2018 ◽  
Vol 4 (1) ◽  
Author(s):  
Gallardo Angel J Lacerda ◽  
Pérez Daysi Abreu ◽  
Pazos Miguel Mazorra ◽  
Caraguay Gustavo P Valdivieso ◽  
Criales Gustavo M Obregón ◽  
...  
Keyword(s):  
Head Trauma ◽  
Decompressive Craniectomy ◽  
Severe Head Trauma
Sign in / Sign up

Export Citation Format

Share Document