Sunday, September 11, 2016


The Bottom Line - September 8, 2016 - By Steve Mathieu
Trial of Decompressive Craniectomy for Traumatic Intracranial Hypertension
Hutchinson. Published on line 7th Sept; NEJM 2016; DOI: 10.1056/NEJMoa1605215
"Clinical Question
In patients with a traumatic brain injury (TBI) and refractory intracranial hypertension, does decompressive craniectomy, result in more favourable mortality and neurological outcomes at 6 months, compared with barbiturate coma and continued medical management?...
Authors’ Conclusions
At 6 months, decompressive craniectomy in patients with TBI and refractory intracranial hypertension resulted in lower mortality and higher rates of vegetative state, lower severe disability, and upper severe disability than medical care
The Bottom Line
Decompressive craniectomy in patients with TBI and persistently raised intracranial pressure, after stage 1 and 2 management, was associated with lower mortality than medical management. However, more survivors in the surgical group than in the medical group were dependent on others. With data now available from DECRA and RESCUEicp, there is likely to be concern that life saving surgery may not predictably result in sufficiently good functional survival. Further investigations, exploring patient selection, longer term recovery and quality of life"