title: Decompressive hemicraniectomy for pediatric traumatic brain injury: long-term outcome based on quality of life.
abstract: OBJECTIVE
  The impact of decompressive hemicraniectomy (DCH) on the overall outcome of pediatric brain injury patients has not been fully determined. In this paper, the authors performed a systematic review of patient outcome based on quality of life following DCH in a pediatric population.
  
  
  METHODS
  We describe our experience with decompressive craniectomy in pediatric patients and perform a literature review and pooled outcomes analysis to supplement these findings. A total of 13 children underwent DCH for intractable intracranial pressure in our institution from 2000 to 2008. Follow-up was available in 11 patients with 1 death (9%) and 7 survivors (70%) obtaining a favorable outcome (Glasgow Outcome Scale, GOS, scores = 4-5).
  
  
  RESULTS
  A literature review to determine the usefulness of DCH identified 17 articles that, when combined with our series, resulted in 186 pediatric DCH cases. Pooled outcomes found 42 deaths and 112 patients who had favorable outcomes at 6 months. The average 6-month mortality was 21.1%, and the pooled mean quality of life among survivors 0.75 (0.68-0.82), midway between moderate disability and good outcome.
  
  
  CONCLUSIONS
  Based on our findings, DCH results in a majority of pediatric patients having a good outcome based on the GOS score.
authors.affiliation: Department of Neurosurgery, University of Pennsylvania Health System, Philadelphia, PA 19104, USA. arun.jacob@uphs.upenn.edu
authors.forename: Arun T
authors.initials: AT
authors.lastname: Jacob
authors.forename: Gregory G
authors.initials: GG
authors.lastname: Heuer
authors.forename: Ryan
authors.initials: R
authors.lastname: Grant
authors.forename: Patrick
authors.initials: P
authors.lastname: Georgoff
authors.forename: Shabbar F
authors.initials: SF
authors.lastname: Danish
authors.forename: Phillip B
authors.initials: PB
authors.lastname: Storm
authors.forename: Sherman C
authors.initials: SC
authors.lastname: Stein
mesh_terms: D001930:Brain Injuries / Q000401:mortality / Q000523:psychology / Q000601:surgery*; D002648:Child; D003399:Craniotomy / Q000639:trends*; D019299:Decompression, Surgical / Q000639:trends*; D006801:Humans; D011788:Quality of Life / Q000523:psychology; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome