Radiographic predictors of clinical outcome in traumatic brain injury after decompressive craniectomy.
BACKGROUND
Primary decompressive craniectomy (DC) is considered for traumatic brain injury (TBI) patients with clinical deterioration, presenting large amounts of high-density lesions on computed tomography (CT). Postoperative CT findings may be suitable for prognostic evaluation. This study evaluated the radiographic predictors of clinical outcome and survival using pre- and postoperative CT scans of such patients.


METHODS
We enrolled 150 patients with moderate to severe TBI who underwent primary DC. They were divided into two groups based on the 6-month postoperative Glasgow Outcome Scale Extended scores (1-4, unfavorable; 5-8, favorable). Radiographic parameters, including hemorrhage type, location, presence of skull fracture, midline shifting, hemispheric diameter, effacement of cisterns, parenchymal hypodensity, and craniectomy size, were reviewed. Stepwise logistic regression analysis was used to identify the prognostic factors of clinical outcome and 6-month mortality.


RESULTS
Multivariable logistic regression analysis revealed that age (odds ratio [OR] = 1.09; 95% confidence interval [CI] 1.032-1.151; p = 0.002), postoperative low density (OR = 12.58; 95% CI 1.247-126.829; p = 0.032), and postoperative effacement of the ambient cistern (OR = 14.52; 95% CI 2.234-94.351; p = 0.005) and the crural cistern (OR = 4.90; 95% CI 1.359-17.678; p = 0.015) were associated with unfavorable outcomes. Postoperative effacement of the crural cistern was the strongest predictor of 6-month mortality (OR = 8.93; 95% CI 2.747-29.054; p = 0.000).


CONCLUSIONS
Hemispheric hypodensity and effacement of the crural and ambient cisterns on postoperative CT after primary DC seems to associate with poor outcome in patients with TBI.
['Hong|Jung Ho|JH|', 'Jeon|Ikchan|I|', 'Seo|Youngbeom|Y|', 'Kim|Seong Ho|SH|', 'Yu|Dongwoo|D|0000-0003-2100-5452']
D000293:Adolescent D000328:Adult D000368:Aged D000369:Aged, 80 and over D000070642:Brain Injuries, Traumatic D056424:Decompressive Craniectomy D005260:Female D005500:Follow-Up Studies D023261:Glasgow Outcome Scale D006801:Humans D053208:Kaplan-Meier Estimate D016015:Logistic Models D008297:Male D008875:Middle Aged D015999:Multivariate Analysis D015588:Observer Variation D011379:Prognosis D012189:Retrospective Studies D014057:Tomography, X-Ray Computed D016896:Treatment Outcome D055815:Young Adult
Traumatic brain injury Decompressive craniectomy Postoperative CT scan Prognosis