title: Comparison of outcomes following decompressive craniectomy in children with accidental and nonaccidental blunt cranial trauma.
abstract: OBJECTIVE
  The goal of this study was to compare clinical outcomes following decompressive craniectomy performed for intracranial hypertension in children with nonaccidental, blunt cranial trauma with outcomes of decompressive craniectomy in children injured by other mechanisms.
  
  
  METHODS
  All children in a prospectively acquired database of trauma admissions who underwent decompressive craniectomy over a 9-year span, beginning January 1, 2000, are the basis for this study. Clinical records and neuroimaging studies were systematically reviewed.
  
  
  RESULTS
  Thirty-seven children met the inclusion criteria. Nonaccidental head trauma was the most common mechanism of injury (38%). The mortality rate in patients with abusive brain injury (35.7%) was significantly higher (p < 0.05) than in patients with other causes of traumatic brain injury (4.3%). Children with inflicted head injuries had a 12-fold increase in the odds of death and 3-fold increase in the odds of a poor outcome (King's Outcome Scale for Closed Head Injury score of 1, 2, or 3).
  
  
  CONCLUSIONS
  Children with nonaccidental blunt cranial trauma have significantly higher mortality following decompressive craniectomy than do children with other mechanisms of injury. This understanding can be interpreted to mean either that the threshold for decompression should be lower in children with nonaccidental closed head injury or that decompression is unlikely to alter the path to a fatal outcome. If decompressive craniectomy is to be effective in reducing mortality in the setting of nonaccidental blunt cranial trauma, it should be done quite early.
authors.affiliation: Department of Neurosurgery, The Children's Hospital and University of Colorado, Aurora, Colorado 80045, USA.
authors.forename: Chima O
authors.initials: CO
authors.lastname: Oluigbo
authors.forename: C Corbett
authors.initials: CC
authors.lastname: Wilkinson
authors.forename: Nicholas V
authors.initials: NV
authors.lastname: Stence
authors.forename: Laura Z
authors.initials: LZ
authors.lastname: Fenton
authors.forename: Sean A
authors.initials: SA
authors.lastname: McNatt
authors.forename: Michael H
authors.initials: MH
authors.lastname: Handler
mesh_terms: D000059:Accidents; D000063:Accidents, Traffic; D000293:Adolescent; D001265:Athletic Injuries / Q000000981:diagnostic imaging / Q000601:surgery; D001930:Brain Injuries / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D002648:Child; D002649:Child Abuse; D002675:Child, Preschool; D003399:Craniotomy / Q000379:methods*; D019299:Decompression, Surgical / Q000379:methods*; D019988:Children with Disabilities; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D007223:Infant; D008297:Male; D018458:Persistent Vegetative State; D020127:Recovery of Function; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*