Background The use of decompressive craniectomy (DC) as an aggressive therapy for traumatic brain injury (TBI) has gained renewed interest. While age and the Glasgow Coma Scale (GCS) are frequently correlated with outcome in TBI, their prognostic values after decompressive cra-niectomy are ill-defined.
Methods We retrospectively reviewed data from 103 TBI patients treated with DC from 2001 to 2003. Age, preoper-ative GCS, and injury severity scores were recorded. Outcome at time of discharge was measured with the Glasgow Outcome Scale (GOS). Patients were stratified into the following age groups: <35, 35–49, 50–64, and ≥65 years. Spearman's correlation coefficients between age, GCS, and GOS were calculated for the entire population and each age group.
Findings Mortality rates for each age group were 19.2%, 66.7%, 60%, and 80%, respectively. There was a significant negative correlation between age and GOS (r=−0.42, p< 0.0001) and patients <35 years had significantly better outcomes than patients ≥35 years (p<0.0001). The overall correlation between GCS and GOS did not reach significance (r=0.18, p=0.076). When stratified by age, there was a significant correlation between GCS and GOS only in patients 35–49 years (r=0.51, p=0.011). Conclusions This data suggests that in TBI patients treated with DC, age correlates with outcome while the correlation between GCS and outcome is age-dependent.
Keywords
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsPreview
Unable to display preview. Download preview PDF.
References
Albanese J, Leone M, Alliez JR, Kaya JM, Antonini F, Alliez B, Martin C (2003) Decompressive craniectomy for severe traumatic brain injury: evaluation of the effects at one year. Crit Care Med 31:2535–2538
Balestreri M, Czosnyka M, Chatfield DA, Steiner LA, Schmidt EA, Smielewski P, Matta B, Pickard JD (2004) Predictive value of Glasgow Coma Scale after brain trauma: change in trend over the past ten years. J Neurol Neurosurg Psychiatry 75:161–162
Coplin WM, Cullen NK, Policherla PN, Vinas FC, Wilseck JM, Zafonte RD, Rengachary SS (2001) Safety and feasibility of craniectomy with duraplasty as the initial surgical intervention for severe traumatic brain injury. J Trauma 50:1050–1059
Demetriades D, Kuncir E, Murray J, Velmahos GC, Rhee P, Chan L (2004) Mortality prediction of head Abbreviated Injury Score and Glasgow Coma Scale: analysis of 7,764 head injuries. J Am Coll Surg 199:216–222
Gennarelli TA, Champion HR, Copes WS, Sacco WJ (1994) Comparison of mortality, morbidity, and severity of 59,713 head injured patients with 114,447 patients with extracranial injuries. J Trauma 37:962–968
Jennett B, Teasdale G, Galbraith S, Braakman R, Avezaat C, Minderhoud J, Heiden J, Kurze T, Murray G, Parker L (1979) Prognosis in patients with severe head injury. Acta Neurochir Suppl (Wien) 28:149–152
Levati A, Farina ML, Vecchi G, Rossanda M, Marrubini MB (1982) Prognosis of severe head injuries. J Neurosurg 57:779–783
Levin HS, Gary HE Jr., Eisenberg HM, Ruff RM, Barth JT, Kreutzer J, High WM Jr., Portman S, Foulkes MA, Jane JA et al (1990) Neurobehavioral outcome 1 year after severe head injury. Experience of the Traumatic Coma Data Bank. J Neurosurg 73:699–709
Marion DW, Carlier PM (1994) Problems with initial Glasgow Coma Scale assessment caused by prehospital treatment of patients with head injuries: results of a national survey. J Trauma 36:89–95
Marshall LF, Klauber GT, Eisenberg HM (1991) The outcome of severe closed head injury. J Neurosurg 75:S28–S36
Munch E, Horn P, Schurer L, Piepgras A, Paul T, Schmiedek P (2000) Management of severe traumatic brain injury by decom-pressive craniectomy. Neurosurgery 47:315–322
Polin RS, Shaffrey ME, Bogaev CA, Tisdale N, Germanson T, Bocchicchio B, Jane JA (1997) Decompressive bifrontal craniec-tomy in the treatment of severe refractory posttraumatic cerebral edema. Neurosurgery 41:84–92
Pompucci A, De Bonis P, Pettorini B, Petrella G, Di Chirico A, Anile C (2007) Decompressive craniectomy for traumatic brain injury: patient age and outcome. J Neurotrauma 24:1182–1188
Teasdale G, Jennett B (1974) Assessment of coma and impaired consciousness. A practical scale. Lancet 2:81–84
Teasdale G, Jennett B (1976) Assessment and prognosis of coma after head injury. Acta Neurochir (Wien) 34:45–55
Vollmer DG, Torner JC, Jane JA, Sadovnic B, Charlesbois D, Eisenberg HM, Foulkes MA, Marmarou A, Marshall LF (1991) Age and outcome following traumatic coma: why do older patients fare worse? J Neurosurg S75:37–49
Author information
Authors and Affiliations
Editor information
Rights and permissions
Copyright information
© 2008 Springer-Verlag/Wien
About this paper
Cite this paper
Potts, M.B., Chi, J.H., Meeker, M., Holland, M.C., Hemphill III, J.C., Manley, G.T. (2008). Predictive values of age and the Glasgow Coma Scale in traumatic brain injury patients treated with decompressive craniectomy. In: Steiger, H.J. (eds) Acta Neurochirurgica Supplements. Acta Neurochirurgica Supplementum, vol 102. Springer, Vienna. https://doi.org/10.1007/978-3-211-85578-2_22
Download citation
DOI: https://doi.org/10.1007/978-3-211-85578-2_22
Publisher Name: Springer, Vienna
Print ISBN: 978-3-211-85577-5
Online ISBN: 978-3-211-85578-2
eBook Packages: MedicineMedicine (R0)