Department of Surgery and Anaesthesia, University of Otago Wellington, Wellington, New Zealand.
Department of Public Health, University of Otago Wellington, Wellington, New Zealand.
Br J Neurosurg. 2021 Jun;35(3):329-333. doi: 10.1080/02688697.2020.1812521. Epub 2020 Sep 8.
Decompressive craniectomy remains controversial because of uncertainty regarding its benefit to patients; this study aimed to explore current practice following the RESCUEicp Trial, an important study in the evolving literature on decompressive craniectomies.
Neurosurgeons in New Zealand, Australia, USA and Nepal were sent a survey consisting of two case scenarios and several multi-choice questions exploring their utilisation of decompressive craniectomy following the RESCUEicp Trial.
One in ten neurosurgeons (n=6, 10.3%) were no longer performing decompressive craniectomies for TBI following the RESCUEicp Trial and two fifths (n=23, 39.7%) were less enthusiastic. Most neurosurgeons would not operate in the face of severe disability (n=46, 79.3%) or vegetative state/death (n=57, 98.3%). Neurosurgeons tended give more optimistic prognoses than the CRASH prognostic model. Those who suggested more pessimistic prognoses and those who use decision support tools were less likely to advise decompressive surgery.
RESCUEicp has had a notable impact on neurosurgeons and their management of TBI. Although there remains no clear clinical consensus on the contraindications for decompressive craniectomy, most neurosurgeons would not operate if severe disability or vegetative state (the rates of which are increased by such surgery) seemed likely. Whilst unreliable, prognostic estimates still have an impact on clinical decision making and neurosurgical management. Wider use of decision support tools should be considered.
去骨瓣减压术的疗效仍存在争议，因为其对患者的益处尚不确定；本研究旨在探讨 RESCUEicp 试验后该手术的实际应用情况，该试验是去骨瓣减压术相关文献演变中的一项重要研究。
向新西兰、澳大利亚、美国和尼泊尔的神经外科医生发送了一份调查问卷，其中包含两个病例场景和几个多项选择题，以探讨他们在 RESCUEicp 试验后对去骨瓣减压术的应用情况。
十分之一的神经外科医生（n=6，10.3%）在 RESCUEicp 试验后不再对 TBI 进行去骨瓣减压术，五分之二（n=23，39.7%）的医生对此术式的热情降低。大多数神经外科医生在面对严重残疾（n=46，79.3%）或植物人状态/死亡（n=57，98.3%）时不会进行手术。神经外科医生倾向于做出比 CRASH 预后模型更乐观的预后判断。那些预测结果更悲观以及使用决策支持工具的医生，不太可能建议进行减压手术。
RESCUEicp 对神经外科医生及其 TBI 管理产生了显著影响。尽管目前对于去骨瓣减压术的禁忌证仍没有明确的临床共识，但如果严重残疾或植物人状态（此类手术会增加这些情况的发生率）似乎很有可能发生，大多数神经外科医生不会进行手术。尽管预后评估不可靠，但仍会对临床决策和神经外科管理产生影响。应考虑更广泛地使用决策支持工具。
