Long-term outcomes of early decompressive craniectomy in pediatric severe traumatic brain injury

OBJECTIVE: Limited data exist regarding the outcomes of early decompressive craniectomy (DC) in pediatric patients who have sustained severe traumatic brain injury (TBI). In this study, using data from the Approaches and Decisions in Acute Pediatric TBI Trial (ADAPT), the authors' primary hypothesis was that there was no significant difference in long-term outcomes in children who underwent early versus late DC following severe TBI. METHODS: All pediatric patients with severe TBI who underwent DC within the first 7 days of their ICU stay were included in this study. Early DC was defined as a DC performed within 24 hours of admission. Late DC was defined as DC performed after 24 hours. A propensity score-matching methodology was used to analyze the results. RESULTS: Of the 1000 enrolled patients in the ADAPT, 273 patients qualified for this study. Propensity score matching created 44 pairs of patients. Pair-matched analysis showed no significant difference in in-hospital mortality (5 [11.4%] vs 6 [13.6%], p > 0.99), 30-day mortality (4 [9.1%] vs 5 [11.4%], p > 0.99), and 60-day mortality (6 [13.6%] vs 5 [11.4%], p > 0.99) between the early and the late groups. The 6-month Glasgow Outcome Scale-Extended (GOS-E) score (favorable scores 1-4: 14 [42.4%] vs 10 [27.8%], p = 0.306) between the groups was similar. There were no significant differences identified between the groups regarding the ICU stay (median [95% CI] 15 [13-21] vs 15 [13-22] days, p = 0.558). There was a significant difference between early and late DC in hospital length of stay (median [95% CI] 24 [18-30] vs 31 [19-39] days, p = 0.049). CONCLUSIONS: Early DC did not show any significant long-term benefit in terms of mortality or GOS-E score but resulted in a shorter hospital length of stay.