Detailed long-term outcome analysis after decompressive craniectomy for severe traumatic brain injury.
OBJECTIVE
To assess detailed long-term clinical outcome at least 1 year after decompressive craniectomy (DC) in patients with severe traumatic brain injury (TBI).


METHODS
One hundred and thirty-one patients with severe TBI underwent DC between September 1997 and September 2005. Outcome was measured using the Glasgow Outcome Scale (GOS). Detailed outcome analysis was performed using Glasgow Outcome Scale Extended, Short-Form 36 (SF-36), Beck Depression Inventory, Trail Making Test B (TMT-B), Digit-Symbol Test (DST) and Barthel Index (BI).


RESULTS
Sixty-three patients (48.1%) died during their initial hospital stay, 27 (20.6%) were discharged in a vegetative state, 32 (24.4%) with severe disability and nine (6.9%) with moderate disability (GOS 3 and 4, respectively). At time of follow-up 75 patients (67.7%) were either dead or in a vegetative state. Thirty patients with GOS >2 were recruited for a detailed outcome analysis: Major depression, neurologic deficits and impaired TMT-B and DST performances were common and significantly more prevalent than in normative controls. Yet, patients reported only modestly reduced SF-36 and high BI scores.


CONCLUSIONS
Despite multiple health-related problems after DC, many patients proved highly functional in activities of daily living and reported qualities of life not significantly inferior to that of healthy individuals. Depression was common and requires to be addressed with patients and caregivers. Better targeted therapies could improve neuropsychological and psychiatric outcomes in this complex cohort.
Department of Neurosurgery of the Unfallkrankenhaus Berlin, Germany. ahmadi@med.uni-duesseldorf.de
Sebastian A
SA
Ahmadi
Ullrich
U
Meier
Johannes
J
Lemcke
D000203:Activities of Daily Living / Q000523:psychology; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001930:Brain Injuries / Q000523:psychology* / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D056424:Decompressive Craniectomy / Q000401:mortality / Q000523:psychology* / Q000534:rehabilitation; D003866:Depressive Disorder / Q000523:psychology*; D006233:Persons with Disabilities / Q000523:psychology; D005260:Female; D015600:Glasgow Coma Scale; D023261:Glasgow Outcome Scale; D017052:Hospital Mortality; D006801:Humans; D019586:Intracranial Hypertension / Q000401:mortality / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D018458:Persistent Vegetative State / Q000401:mortality / Q000523:psychology*; D011788:Quality of Life / Q000523:psychology*; D016896:Treatment Outcome; D055815:Young Adult