Severe traumatic brain injury in children-a single center experience regarding therapy and long-term outcome

Object The impact of intracranial pressure (ICP), decompressive craniectomy (DC), extent of ICP therapy, and extracranial complications on long-term outcome in a single-center pediatric patient population with severe traumatic brain injury (TBI) is examined. Methods Data of pediatric (<= 16 years) TBI patients were retrospectively reviewed using a prospectively acquired database on neurosurgical interventions between April 1996 and March 2007 at the Charite Berlin. The patients' records, neuroimages, admission Glasgow Coma Scale (GCS) score, the time to craniectomy for hematoma evacuation/DC, and the extent of ICP therapy were reviewed. Twelve-month and long-term outcome was evaluated (Glasgow Outcome Scale). Results Fifty-three pediatric TBI patients [mean age 8.41 (0-16) years] were studied. Patients were categorized into two groups, with DC (n=14) and without DC (n=39). DC was performed 3 +/- 3.98 median, quartiles 2 (0-3.75) days post-trauma. In the majority of children (n=9; 64%), surgical decompression was performed early within 2 days post-trauma. (0.8 +/- 0.9 days). The DC group tended to be older (median age 12 vs. 7 years, p=0.052), had a lower GCS (3 vs. 6.5, p<0.01), and had a 3-fold longer stay on the ICU (20 vs. 6.5 days, p<0.03) compared to the conservatively treated group. Mean follow-up duration (n=30) was 5.2 +/- 2.4 years (range 1-10.5). At the most recent follow-up examination, 92% of survivors had returned to school. Conclusion Though initial GCS was worse in pediatric TBI patients who underwent decompressive craniectomy compared to the conservatively treated patients, long-term outcome was comparable. In children, decompressive craniectomy might be favored early in the management of uncontrollable ICP.