title: Long-term outcome and health status in decompressive craniectomized patients with intractable intracranial pressure after severe brain injury.
abstract: OBJECTIVE
  Decompressive craniectomy (DC) in severe traumatic brain injury (TBI) remains a controversial therapeutic strategy. The long-term functional recovery and health status in a sample of decompressive craniectomized TBI are reported.
  
  
  METHODS
  Patients with TBI who underwent DC were retrospectively investigated. Patients with cerebral haemorrhage (CH) and DC were considered as control group. In all survival patients admitted to a neuro-rehabilitation setting, the modified Rankin (mRS), Glasgow Outcome scale (GOS) and Barthel Scales (BS) were administered at admission, discharge, 1 year and follow-up. The quality-of-life was evaluated with the SF-36 questionnaire at follow-up (41.1±16.6 months).
  
  
  RESULTS
  Seventy (33 F, 37 M, mean age=46.8, SD=18.8) patients were enrolled: 46 (20 F, 26 M) subjects with TBI and 24 (13 F, 11 M) with CH. After surgery, 11 (23.9%) and 10 (41.6%) subjects in the TBI and CH group, respectively, died. The mean Barthel scores were 4.0 (SD=5.9), 60.9 (SD=37.5), 63.7 (SD=35.1) and 67.3 (SD=38.2) (p<0.001) and median GOS was 3, 4, 4 and 4 at admission, discharge, 1 year and follow-up, respectively, in TBI patients. Seventeen (36.9%) patients with TBI and four (16.6%) with CH made a full recovery. The SF-36 questionnaire showed significant abnormalities in all domains of health status in both groups.
  
  
  CONCLUSIONS
  Craniectomized patients with TBI achieved good long-term outcome, although they experienced significant difficulties in health status.
authors.affiliation: Neuro-rehabilitation Unit, Scientific Institute Casa Sollievo della Sofferenza, Viale dei Cappuccini 1, San Giovanni Rotondo (FG), Italy. d.intiso@operapadrepio.it
authors.forename: Domenico
authors.initials: D
authors.lastname: Intiso
authors.forename: Teresa
authors.initials: T
authors.lastname: Lombardi
authors.forename: Giuseppina
authors.initials: G
authors.lastname: Grimaldi
authors.forename: Andrea
authors.initials: A
authors.lastname: Iarossi
authors.forename: Maurizio
authors.initials: M
authors.lastname: Tolfa
authors.forename: Mario
authors.initials: M
authors.lastname: Russo
authors.forename: Filomena
authors.initials: F
authors.lastname: Di Rienzo
mesh_terms: D001930:Brain Injuries / Q000401:mortality / Q000503:physiopathology* / Q000601:surgery; D002543:Cerebral Hemorrhage / Q000401:mortality / Q000503:physiopathology / Q000601:surgery; D056424:Decompressive Craniectomy / Q000379:methods*; D005260:Female; D006304:Health Status; D006801:Humans; D019586:Intracranial Hypertension / Q000401:mortality / Q000503:physiopathology* / Q000601:surgery; D007427:Intracranial Pressure / Q000502:physiology; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D020127:Recovery of Function / Q000502:physiology*; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome