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Decompressive Craniectomy Is Associated With Good Quality of Life Up to 10 Years After Rehabilitation From Traumatic Brain Injury.

Crit Care Med. 2020;10.1097/CCM.0000000000004387. doi:10.1097/CCM.0000000000004387 [published online ahead of print, 2020 May 18].

Authors/Editors: Rauen K, Reichelt L, Probst P, Schäpers B, Müller F, Jahn K, Plesnila N.
Publication Date: 2020

Abstract


Objectives: Traumatic brain injury is the number one cause of death in children and young adults and has become increasingly prevalent in the elderly. Decompressive craniectomy prevents intracranial hypertension but does not clearly improve physical outcome 6 months after traumatic brain injury. However, it has not been analyzed if decompressive craniectomy affects traumatic brain injury patients’ quality of life in the long term.

Design: Therefore, we conducted a cross-sectional study assessing health-related quality of life in traumatic brain injury patients with or without decompressive craniectomy up to 10 years after injury.

Setting: Former critical care patients.

Patients: Chronic traumatic brain injury patients having not (n = 37) or having received (n = 98) decompressive craniectomy during the acute treatment.

Measurements and Main Results: The Quality of Life after Brain Injury questionnaire was used as outcome measure with a total score from zero to 100, representing lowest and best health-related quality of life, respectively. Health-related quality of life was compared between patients with or without decompressive craniectomy for the entire cohort, for the traumatic brain injury severity (mild, moderate, severe) measured by the initial Glasgow Coma Scale, for age and time variables (age at traumatic brain injury, age at survey, elapsed time since traumatic brain injury) using the Mann-Whitney U test. Differences were considered significant at a p value of less than 0.05.

Decompressive craniectomy was necessary in all initial traumatic brain injury severity groups. Eight percent more decompressive craniectomy patients reported good health-related quality of life with a Quality of Life after Brain Injury total score greater than or equal to 60 compared with the no decompressive craniectomy patients up to 10 years after traumatic brain injury (p = 0.004). Initially, mild classified traumatic brain injury patients had a median Quality of Life after Brain Injury total score of 83 (decompressive craniectomy) versus 62 (no decompressive craniectomy) (p = 0.028). Health-related quality of life regarding physical status was better in decompressive craniectomy patients (p = 0.025). Decompressive craniectomy showed a trend toward better health-related quality of life in the 61–85-year-old reflected by median Quality of Life after Brain Injury total scores of 62 (no decompressive craniectomy) versus 79 (decompressive craniectomy) (p = 0.06).

Conclusions: Our results suggest that decompressive craniectomy is associated with good health-related quality of life up to 10 years after traumatic brain injury. Thus, decompressive craniectomy may have an underestimated therapeutic potential after traumatic brain injury.

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