Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.
A longstanding key concern with decompressive craniectomy is that any effect to increase survival is not necessarily accompanied by an increase in quality of life. That is, perceived benefit may in fact be a movement of a proportion of patients from death to survival with severe disability. This might be interpreted as a worsening of outcome. Severe disability survival has attendant costs to society, no obvious patient benefits and indeed possible patient harm through physical, psychological and emotional suffering. Yet, as Honeybul et al1 detail clearly, quality clinical trials which clearly define the treatment effect of decompressive craniectomy are lacking. Practical conclusions about the treatment effect of decompressive craniectomy on survival and quality of life for any one particular patient are often little more than guesswork or preconceived bias.
The limitations of our current evidence base are in part due to the broader issue of the heterogeneous nature of traumatic brain injury (TBI). As a disease, TBI has numerous differing pathophysiological processes which make it difficult to obtain evidence of efficacy …
Competing interests None.
Provenance and peer review Commissioned; internally peer reviewed.
Data sharing statement OxHEAD unpublished data are subject to confidentiality. Availability will be considered by members of the OxHEAD team following a written request.
Read the full text or download the PDF:
Other content recommended for you
- Ethical considerations for performing decompressive craniectomy as a life-saving intervention for severe traumatic brain injury
- Traumatic brain injury in adults
- Long-term survival with unfavourable outcome: a qualitative and ethical analysis
- Neurotrauma and the rule of rescue
- IMPACT and CRASH prognostic models for traumatic brain injury: external validation in a South-American cohort
- Haemoglobin transfusion threshold in traumatic brain injury optimisation (HEMOTION): a multicentre, randomised, clinical trial protocol
- Traumatic subdural haematoma: integrating case-based clinical judgement with guidelines
- Survival after traumatic brain injury improves with deployment of neurosurgeons: a comparison of US and UK military treatment facilities during the Iraq and Afghanistan conflicts
- Intracranial pressure monitoring in severe traumatic brain injury
- Dyskalaemia following diffuse axonal injury: case report and review of the literature