Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery · 2026
Long-term functional outcomes following pediatric decompressive craniectomy for traumatic brain injury.
СтатьяНазвание и аннотация: Перевод в очереди
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Burwell Julian Michael, Gonzalez Brandon, Ehinnou Blandine, Nasser Lara, Huang Jessica, Schirmer Clemens Maria
Аннотация
PURPOSE: Determine whether there is a difference in 5-year functional outcomes between pediatric head trauma cases who received DC vs. non-operative management (NOM).
METHODS: A seven-year (2017-2024) retrospective, case-control study of 195 pediatric trauma admissions (ages 2-18) at two Level-1 Trauma Centers. Subjects with primary head trauma and GCS ≤ 12 were included. Cases were divided into two matched cohorts based on age, sex, and injury severity. The DC group was characterized by surgical indication, and non-operative management (NOM) interventions were recorded by tier per Brain Trauma Foundation guidelines. Outcomes were assessed annually over five years using GOSE and KOSCHI. Statistical tests included χ2, t-test, and CMH test for outcome shifts.
RESULTS: Twenty-six matched pairs (n = 52) were included in the final analysis. The DC group had markedly worse intracranial pathology, including midline shift (38.46% DC vs 0% NOM, p = .001) and cisternal compression (65.38% DC vs 7.69% NOM, p < .001), along with higher hospital mortality (15.38% DC vs 0% NOM). CMH shift testing of GOSE and KOSCHI demonstrated comparable outcomes between cohorts from years one through four (p = .068). At five years, the NOM group exhibited a trend toward better outcomes (p = .046), although interpretation was limited by a small sample size at this time point (n = 5), with the remainder lost to follow-up. Notably, no DC survivors with available follow-up data demonstrated functional decline over time. On follow-up, neurological symptoms sequelae were more common in the DC group, while psychiatric complaints were more frequently reported in the NOM group.
CONCLUSION: Despite significantly worse intracranial pathology, DC patients who remained in follow-up achieved comparable functional outcomes to NOM patients through four years.
METHODS: A seven-year (2017-2024) retrospective, case-control study of 195 pediatric trauma admissions (ages 2-18) at two Level-1 Trauma Centers. Subjects with primary head trauma and GCS ≤ 12 were included. Cases were divided into two matched cohorts based on age, sex, and injury severity. The DC group was characterized by surgical indication, and non-operative management (NOM) interventions were recorded by tier per Brain Trauma Foundation guidelines. Outcomes were assessed annually over five years using GOSE and KOSCHI. Statistical tests included χ2, t-test, and CMH test for outcome shifts.
RESULTS: Twenty-six matched pairs (n = 52) were included in the final analysis. The DC group had markedly worse intracranial pathology, including midline shift (38.46% DC vs 0% NOM, p = .001) and cisternal compression (65.38% DC vs 7.69% NOM, p < .001), along with higher hospital mortality (15.38% DC vs 0% NOM). CMH shift testing of GOSE and KOSCHI demonstrated comparable outcomes between cohorts from years one through four (p = .068). At five years, the NOM group exhibited a trend toward better outcomes (p = .046), although interpretation was limited by a small sample size at this time point (n = 5), with the remainder lost to follow-up. Notably, no DC survivors with available follow-up data demonstrated functional decline over time. On follow-up, neurological symptoms sequelae were more common in the DC group, while psychiatric complaints were more frequently reported in the NOM group.
CONCLUSION: Despite significantly worse intracranial pathology, DC patients who remained in follow-up achieved comparable functional outcomes to NOM patients through four years.