Department of Pediatrics I, Hand and Reconstructive Surgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
TNBS, Center for Translational Neuro- and Behavioral Sciences, Hand and Reconstructive Surgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
J Neurotrauma. 2022 Jul;39(13-14):944-953. doi: 10.1089/neu.2021.0378.
The effect of decompressive craniectomy (DC) on functional outcomes and mortality in children after severe head trauma is strongly debated. The lack of high-quality evidence poses a serious challenge to neurosurgeons' and pediatric intensive care physicians' decision making in critically ill children after head trauma. This study was conducted to compare DC and medical management in severely head-injured children with respect to short-term outcomes and mortality. Data on patients <18 years of age treated in Germany, Austria, and Switzerland during a 10-year period were extracted from TraumaRegister DGU, forming a retrospective multi-center cohort study. Descriptive and multi-variable analyses were performed to compare outcomes and mortality after DC and medical management. Of 2507 patients, 402 (16.0%) received DC. Mortality was 20.6% after DC and 13.7% after medical management. Poor outcome (death or vegetative state) occurred in 27.6% after DC and in 16.1% after medical management. After risk adjustment by logistic regression modeling, the odds ratio was 1.56 (95% confidence interval 1.01-2.40) for poor outcome at intensive care unit discharge and 1.20 (0.74-1.95) for mortality after DC. In summary, DC was associated with increased odds for poor short-term outcomes in children with severe head trauma. This finding should temper enthusiasm for DC in children until a large randomized controlled trial has answered more precisely if DC in children is beneficial or increases rates of vegetative state.
去骨瓣减压术（DC）对严重颅脑外伤后儿童的功能结局和死亡率的影响存在很大争议。缺乏高质量的证据给神经外科医生和儿科重症监护医生在颅脑外伤后危重病儿童的决策带来了严重挑战。本研究旨在比较 DC 和药物治疗对严重颅脑损伤儿童的短期结局和死亡率的影响。从德国、奥地利和瑞士的创伤登记处 DGU 中提取了 10 年间治疗的<18 岁患者的数据，形成了一项回顾性多中心队列研究。采用描述性和多变量分析比较 DC 和药物治疗后的结局和死亡率。在 2507 例患者中，402 例（16.0%）接受了 DC。DC 后死亡率为 20.6%，药物治疗后死亡率为 13.7%。DC 后不良结局（死亡或植物状态）发生率为 27.6%，药物治疗后为 16.1%。通过逻辑回归模型进行风险调整后，DC 组在重症监护病房出院时不良结局的优势比为 1.56（95%置信区间 1.01-2.40），死亡率的优势比为 1.20（0.74-1.95）。总之，DC 与严重颅脑外伤儿童短期不良结局的几率增加有关。这一发现应使人们对儿童去骨瓣减压术的热情降温，直到一项大型随机对照试验更准确地回答儿童去骨瓣减压术是否有益或是否增加植物状态的发生率。
