Early decompressive craniectomy for neurotrauma: an institutional experience.
BACKGROUND
Neurotrauma centers have developed management protocols on the basis of evidence obtained from literature analysis and institutional experience. This article reviews our institutional experience in the management of severe traumatic brain injury (TBI) at Simòn Bolivar Hospital, the district trauma center for Bogotá's north zone.


METHODS
This is a case control study comparing a group of patients (n: 16) operated for severe TBI between January 2002 and July 2004 according to an institutional management protocol characterized by an early decompressive craniectomy (DC) approach versus a historical control group (n: 20) managed before the implementation of such protocol. Mortality and Glasgow Outcome Score (GOS) at 6 months were used as the main outcome variables.


RESULTS
An early DC protocol implemented within 12 hours from injury in 16 patients with severe isolated TBI and a Marshall score between III or IV was associated with a lesser mortality than the conventional approach with ventriculostomy and Intensive Care Unit (ICU) management alone. The GOS was significantly better in the DC group (p=0.0002) than in the control group.


CONCLUSIONS
The use of an early DC protocol for severe TBI patients (Glasgow Coma Scale <9) had a significantly improved outcome compared with the conventional approach with ventriculostomy and ICU management in Simòn Bolivar Hospital in Bogotá, Colombia.
Rubiano
Andrès Mariano
AM
Neurological Surgery Service, Simòn Bolivar Hospital, Bogotá, Colombia. andresrubiano@hispavista.com
Villarreal
Wilson
W
Hakim
Enrique Jimenez
EJ
Aristizabal
Jorge
J
Hakim
Fernando
F
Dìez
Juan Carlos
JC
Peña
Germàn
G
Puyana
Juan Carlos
JC
D000293:Adolescent; D000328:Adult; D001930:Brain Injuries / Q000401:mortality* / Q000601:surgery*; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D003399:Craniotomy / Q000379:methods*; D019299:Decompression, Surgical / Q000379:methods*; D019317:Evidence-Based Medicine; D005260:Female; D023261:Glasgow Outcome Scale; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D019586:Intracranial Hypertension / Q000401:mortality / Q000601:surgery; D008297:Male; D008875:Middle Aged; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult