Decompressive craniectomy in children with severe traumatic brain injury: a multicentre retrospective study and literature review

Abstract Background Severe traumatic brain injury (TBI) is the most common cause of disability in children. Refractory raised intracranial pressure (ICP) can be a therapeutic challenge. Decompressive craniectomy (DC) can be proposed when medical management is insufficient, but its place is not clearly defined in guidelines. Objective To identify prognostic factors in children with TBI. Methods We performed a retrospective, multicentre study to analyse the long-term outcomes of 150 children with severe TBI treated by DC and to identify prognostic factors. Results In this series, we observed a satisfying neurological evolution (represented by a King’s Outcome Scale for Childhood Head Injury [KOSCHI] score >3) in 62% of children with a mean follow-up of 3,5 years. The mortality rate was 17%. Prognostic factors associated with outcome were: age, initial Glasgow Coma Scale (GCS) score, presence of mydriasis, value of neuromonitoring (ICPmax >30mmHg), and radiological findings (Rotterdam score ≥4). Conclusion This study in a large population confirms that children with severe TBI treated by DC can achieve a good neurological outcome. Further studies are needed to clarify the use of this surgery in the management of children with severe TBI.