Decompressive craniectomy for neurotrauma: the limitations of applying an outcome prediction model.
BACKGROUND
There is currently much interest in the use of decompressive craniectomy for patients with severe head injury. A number of studies have demonstrated that not only can the technique lower intracranial pressure but can also improve outcome. Whilst many patients who would otherwise have died or had a poor outcome now go on to make a good recovery, there is little doubt that complications can have a very significant impact on long term outcome.


METHODS
By using the corticosteroid randomisation after significant head injury (CRASH) collaborators outcome prediction model, three patients were selected who had a similar outcome prediction. All three patients developed intracranial hypertension following trauma and had a decompressive craniectomy.


RESULTS
Despite having a similar outcome prediction only one patient made an uneventful recovery. The remaining two patients suffered significant complications.


CONCLUSIONS
This report illustrates the potential clinical applications and limitations of an outcome prediction model and demonstrates the impact that complications can have on eventual outcome.
Honeybul
Stephen
S
Department of Neurosurgery, Sir Charles Gairdner Hospital and Royal Perth Hospital, Perth, WA, Australia. stephen.honeybul@health.wa.gov.au
Ho
Kwok M
KM
Lind
Christopher R P
CR
Gillett
Grant R
GR
D000328:Adult; D001930:Brain Injuries / Q000000981:diagnostic imaging / Q000601:surgery*; D003399:Craniotomy / Q000706:statistics & numerical data*; D019299:Decompression, Surgical / Q000706:statistics & numerical data*; D004185:Disability Evaluation; D005260:Female; D015600:Glasgow Coma Scale / Q000706:statistics & numerical data; D006801:Humans; D015601:Injury Severity Score; D019586:Intracranial Hypertension / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D015233:Models, Statistical; D009460:Neurologic Examination / Q000706:statistics & numerical data*; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000401:mortality; D011379:Prognosis; D012086:Reoperation; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed; D014904:Western Australia; D055815:Young Adult