Clinical neurology and neurosurgery · 2025
Decompressive craniectomy following traumatic brain injury in pediatric patients: An aggregative and individual patient data meta-analysis.
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Naik Anant, Ramirez Cesar, Hoglund Brandon, Iyer Ankitha, Barrie Umaru, Sandoval-Garcia Carolina, Venteicher Andrew S, Guillaume Daniel, Arnold Paul M
Аннотация
OBJECTIVE: Traumatic brain injury (TBI) in pediatric patients is associated with significant mortality. Management ranges from conservative treatment to decompressive craniectomy (DC). Current guidelines weakly recommend DC in pediatric patients experiencing neurologic deterioration, herniation, or refractory intracranial hypertension. There are significant deficits in the literature regarding the benefits and optimal timing of DC for pediatric TBI. The objective of this review is to address these gaps via the largest meta-analysis on this subject to date.
METHODS: Several electronic databases were searched for articles investigating the utility of DC for patients under 18 years of age suffering from TBI. The primary outcome measures evaluated included in-hospital mortality and Glasgow Outcomes Scale (GOS) scores. Risk of bias was assessed using the Newcastle-Ottawa Scale and Egger's test. Fixed- or random-effects models were employed based on study heterogeneity. A meta-regression was performed for the pooled main effect.
RESULTS: 39 studies with 1332 patients were included for aggregate meta-analysis. No significant difference in mortality or GOS between patients managed with DC versus medical management was observed in this cohort. The results of the multivariable meta-regression in this cohort demonstrated younger age and midline shift greater than 5 mm (MLS) were associated with increased mortality. Intraparenchymal hemorrhage, subarachnoid hemorrhage, high ICP at presentation, delayed DC > 5 days, and unilateral DC were associated with unfavorable neurological outcomes.
CONCLUSION: No significant difference in outcomes was identified between DC versus medical management for severe TBI. Several patient factors were identified that are significantly associated with unfavorable outcomes after DC.
METHODS: Several electronic databases were searched for articles investigating the utility of DC for patients under 18 years of age suffering from TBI. The primary outcome measures evaluated included in-hospital mortality and Glasgow Outcomes Scale (GOS) scores. Risk of bias was assessed using the Newcastle-Ottawa Scale and Egger's test. Fixed- or random-effects models were employed based on study heterogeneity. A meta-regression was performed for the pooled main effect.
RESULTS: 39 studies with 1332 patients were included for aggregate meta-analysis. No significant difference in mortality or GOS between patients managed with DC versus medical management was observed in this cohort. The results of the multivariable meta-regression in this cohort demonstrated younger age and midline shift greater than 5 mm (MLS) were associated with increased mortality. Intraparenchymal hemorrhage, subarachnoid hemorrhage, high ICP at presentation, delayed DC > 5 days, and unilateral DC were associated with unfavorable neurological outcomes.
CONCLUSION: No significant difference in outcomes was identified between DC versus medical management for severe TBI. Several patient factors were identified that are significantly associated with unfavorable outcomes after DC.