title: Emergency decompressive craniectomy for trauma patients with Glasgow Coma Scale of 3 and bilateral fixed dilated pupils.
abstract: BACKGROUND
  Trauma patients with Glasgow Coma Scale (GCS) of 3 and bilateral fixed dilated pupils (BFDP) usually have dismal outcome, and neurosurgeons are less likely to treat such patients aggressively. In this work, the authors assessed whether emergency decompressive craniectomy (EDC) can change the poor outcome of these patients.
  
  
  METHODS
  We reviewed all patients with GCS of 3 and BFDP admitted to our neurosurgical unit from January 2004 to January 2008. Injury data, prehospital times, findings on brain computed tomography (CT) scan, procedures, and outcomes were recorded.
  
  
  RESULTS
  During this period, 21 patients were admitted with GCS of 3 and BFDP following traumatic brain injury (TBI). Brain CT scan showed diffuse brain edema in 17 patients (81%), and in 13 patients (62%) it showed different types of intracranial hemorrhage. All patients received conservative medical treatment. Urgent decompressive bifrontal craniectomy was performed in five patients at a mean of 4.6 h (range 2-6 h) from time of injury. Intracranial pressure (ICP) was recorded hourly by intraparenchymal sensor (Codman, Johnson & Johnson). Although decompressive craniectomy was effective in controlling ICP, all patients with GCS of 3 and BFDP died within 30 days of trauma.
  
  
  CONCLUSIONS
  Despite control of ICP following emergency decompressive craniectomy in patients with severe TBI, GCS of 3, and BFDP, this did not change the dismal outcome of these patients; on the contrary, it may increase the suffering for patients and their families and add unnecessary medical burden. We propose that these patients have irreversible severe brain insult.
authors.affiliation: Department of Neurosciences, Jordan University of Science and Technology, Irbid, Jordan. mojamous@yahoo.com.|Department of Neurosurgery, Faculty of Medicine, Jordan University of Science and Technology, Irbid, P.O.Box 3030, Irbid, 22110, Jordan. mojamous@yahoo.com.
authors.forename: M
authors.initials: M
authors.lastname: Jamous
authors.affiliation: Department of Neurosciences, Jordan University of Science and Technology, Irbid, Jordan.
authors.forename: M
authors.initials: M
authors.lastname: Barbarawi
authors.affiliation: Intensive Care Medicine, Jordan University of Science and Technology, Irbid, Jordan.
authors.forename: S
authors.initials: S
authors.lastname: Samrah
authors.affiliation: Department of Pathology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan.
authors.forename: M N
authors.initials: MN
authors.lastname: Khabaz
authors.affiliation: Physiotherapy Department, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan.
authors.forename: M
authors.initials: M
authors.lastname: Al-Jarrah
authors.affiliation: Department of Neurosciences, Jordan University of Science and Technology, Irbid, Jordan.
authors.forename: S
authors.initials: S
authors.lastname: Dauod
keywords: Decompressive craniectomy; Fixed dilated pupils; GCS of 3; Severe brain injury
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