Jaradat Amer, Al Barbarawi Mohammed M, Jamous Mohammad, Jarrar Sultan, Daoud Suleiman S, Rawabdeh Saif Aldeen, Almasanat Sleem Ra'id, Hulliel Atef F, Tashtoush Shaden, Ahmad Omar A
Department of Neurosurgery, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan.
Department of Neurosurgery, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan.
World Neurosurg. 2025 Apr;196:123827. doi: 10.1016/j.wneu.2025.123827. Epub 2025 Feb 24.
Severe traumatic brain injury (TBI) is a leading cause of mortality and disability in pediatric patients, especially in low- and middle-income countries. TBI significantly impacts child development and incurs substantial health care costs. Management of severe TBI includes evidence-based protocols to prevent and treat increased intracranial pressure (ICP), with decompressive craniectomy (DC) as a rescue measure. This study investigates the role of early DC in improving outcomes for children with severe TBI.
A retrospective study was conducted from January 2003 to January 2023 at King Abdullah University Hospital, the main tertiary hospital in North Jordan. This study evaluated pediatric patients (under 16 years old) admitted with severe TBI who underwent early DC (within 24 hours).
This study of 45 pediatric patients undergoing DC for severe TBI found a male predominance (75.6%) and a mean age of 4.3 years. Favorable outcomes (Glasgow Outcome Score 4-5) were achieved in 67% of cases. Pupillary abnormalities were significantly associated with prognosis (P = 0.004), but surgical timing (<6 vs. >6 hours) was not (P = 0.661). The in-hospital mortality rate was 24%, with complications in 35.6% of patients. ICP monitoring was performed in 26.7% of patients.
DC remains a crucial intervention for pediatric patients with severe TBI, primarily to control ICP. Our study found no significant difference in outcomes between early and late DC, aligning with prior research. However, pupillary abnormalities emerged as a key prognostic factor. Our findings highlight the need for further prospective multicenter studies to refine surgical timing for optimal outcomes.
重型创伤性脑损伤（TBI）是儿科患者死亡和残疾的主要原因，在低收入和中等收入国家尤为如此。TBI对儿童发育有重大影响，并产生巨额医疗费用。重型TBI的管理包括预防和治疗颅内压（ICP）升高的循证方案，减压颅骨切除术（DC）作为一种抢救措施。本研究调查早期DC在改善重型TBI患儿预后中的作用。
2003年1月至2023年1月在约旦北部主要的三级医院阿卜杜拉国王大学医院进行了一项回顾性研究。本研究评估了因重型TBI入院并接受早期DC（24小时内）的儿科患者（16岁以下）。
本项针对45例因重型TBI接受DC的儿科患者的研究发现，男性占主导（75.6%），平均年龄为4.3岁。67%的病例获得了良好预后（格拉斯哥预后评分4 - 5分）。瞳孔异常与预后显著相关（P = 0.004），但手术时机（<6小时与>6小时）与预后无关（P = 0.661）。住院死亡率为24%，35.6%的患者出现并发症。26.7%的患者进行了ICP监测。
DC仍然是重型TBI儿科患者的关键干预措施，主要用于控制ICP。我们的研究发现早期和晚期DC在预后方面无显著差异，这与先前的研究一致。然而，瞳孔异常是一个关键的预后因素。我们的研究结果凸显了进一步开展前瞻性多中心研究以优化手术时机从而获得最佳预后的必要性。
