The Short-Term Impact of Decompressive Craniectomy in Pediatric Patients with Severe Traumatic Brain Injury: A Retrospective Matched Cohort Study

TL;DR

A study on children with severe brain injuries found that decompressive craniectomy may help with short-term brain function but does not reduce deaths or hospital stays.

Contribution

This study provides new insights into the short-term effects of decompressive craniectomy in children with severe traumatic brain injury.

Findings

Decompressive craniectomy did not reduce in-hospital mortality in children with severe TBI.

DC was associated with better neurological status at discharge, though not at 3 months.

No significant differences were found in ICU or hospital stay durations between groups.

Abstract

What are the main findings?
In a 1:1 matched cohort (53 DC; 53 non-DC), decompressive craniectomy did not reduce in-hospital mortality (17.0% vs. 26.4%, p = 0.239) or resource use (duration of ventilation, ICU stay, total hospital stay; all p > 0.05).DC was associated with better neurological status at discharge (PCPC, p = 0.029); the difference at 3 months was not statistically significant but showed a near-significant trend (p = 0.057).

In a 1:1 matched cohort (53 DC; 53 non-DC), decompressive craniectomy did not reduce in-hospital mortality (17.0% vs. 26.4%, p = 0.239) or resource use (duration of ventilation, ICU stay, total hospital stay; all p > 0.05).

DC was associated with better neurological status at discharge (PCPC, p = 0.029); the difference at 3 months was not statistically significant but showed a near-significant trend (p = 0.057).

What are the implications of the main findings?
For children with severe TBI who meet surgical criteria, DC may confer short-term neurological benefits without improving short-term survival or length of stay—useful for family counseling and perioperative expectation-setting.Confirmation requires adequately powered prospective studies with standardized ICP/CPP monitoring and longer follow-up to determine durability and to identify subgroups most likely to benefit.

For children with severe TBI who meet surgical criteria, DC may confer short-term neurological benefits without improving short-term survival or length of stay—useful for family counseling and perioperative expectation-setting.

Confirmation requires adequately powered prospective studies with standardized ICP/CPP monitoring and longer follow-up to determine durability and to identify subgroups most likely to benefit.

Background/Objectives: Decompressive craniectomy (DC) is commonly applied to manage refractory intracranial hypertension in severe traumatic brain injury (TBI). However, its role and benefits in pediatric populations remain uncertain. Clarifying whether DC provides measurable clinical advantages in children with severe TBI may inform treatment strategies and family counseling. Methods: We conducted a retrospective, one-to-one matched cohort study at a tertiary pediatric center (2014–2023). Fifty-three children with severe TBI who underwent DC were matched with fifty-three non-DC patients based on age, Glasgow Coma Scale score, cranial CT findings, and pupillary response at admission to ensure comparable injury severity. Demographic data, clinical features, and outcomes were collected. Primary outcomes were in-hospital mortality and Pediatric Cerebral Performance Category (PCPC) scores at discharge and 3 months. Secondary outcomes included duration of mechanical ventilation, intensive care unit (ICU) stay, and total hospital stay. Results: Mortality did not differ significantly between DC and non-DC groups (17.0% vs. 26.4%, p = 0.239). DC patients had better PCPC scores at discharge (p = 0.029). At 3 months, the between-group difference was not statistically significant but showed a near-significant trend (p = 0.057). No significant differences were observed in duration of ventilation (p = 0.100), ICU stay (p = 0.348), or hospital stay (p = 0.678). Conclusions: DC may not reduce short-term mortality in pediatric severe TBI but appears to be associated with more favorable neurological outcomes at discharge. Larger, adequately powered studies with standardized monitoring and longer follow-up are needed to clarify the durability and scope of potential benefits in this population.

Figures