title: Predictors of poor outcome of decompressive craniectomy in pediatric patients with severe traumatic brain injury: a retrospective single center study from Pakistan.
abstract: OBJECTIVE
  This study aimed to determine the risk factors associated with poor outcome of decompressive craniectomy (DC) for severe traumatic brain injury (TBI) in pediatric patients.
  
  
  METHODS
  This retrospective study is conducted on pediatric population (age 1-15 years) presenting with TBI who underwent DC at our institute between January 2000 and 2010. Based on Glasgow outcome score (GOS) at a minimum follow-up of 5 months, patients were divided into two groups, namely poor outcome (GOS 1, 2, and 3) and good outcome (GOS 4 and 5). Records were reviewed and analyzed for preoperative and intraoperative predictors.
  
  
  RESULTS
  We found 25 patients who were eligible as per selection criteria. Mean age at presentation was 6 ± 4 years and there was male preponderance (84%). Fall (60%) was the most common mechanism of injury followed by gunshots and road traffic accident. On univariate analysis, presenting GCS ≤5 (p value = 0.009), delay in presentation of more than 150 min (p value = 0.010), DC performed after more than 4 h of arrival in hospital (p value = 0.042), and intraoperative blood loss exceeding 300 ml (p value = 0.001) were significant predictors of poor outcome.
  
  
  CONCLUSIONS
  Our study suggests that DC in children is not only a life-saving procedure, but also leads to a good functional outcome after severe injury. However, patient selection still remains an important aspect, and the above-mentioned factors should be considered while deciding for DC to improve survival. Further prospective studies on larger sample size are warranted to validate our results.
authors.affiliation: Section of Neurosurgery, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan.
authors.forename: Saad Akhtar
authors.initials: SA
authors.lastname: Khan
authors.forename: Hussain
authors.initials: H
authors.lastname: Shallwani
authors.forename: Muhammad Shahzad
authors.initials: MS
authors.lastname: Shamim
authors.forename: Ghulam
authors.initials: G
authors.lastname: Murtaza
authors.forename: Syed Ather
authors.initials: SA
authors.lastname: Enam
authors.forename: Reema Obaid
authors.initials: RO
authors.lastname: Qureshi
authors.forename: Muhammad Zubair
authors.initials: MZ
authors.lastname: Tahir
mesh_terms: D000293:Adolescent; D001930:Brain Injuries / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D056424:Decompressive Craniectomy; D005260:Female; D023261:Glasgow Outcome Scale; D006801:Humans; D007223:Infant; D008297:Male; D010154:Pakistan; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome