Objectives Managing raised intracranial pressure (ICP) in traumatic brain injury (TBI) has been the centre of debate. Recent publications (such as RescueICP) have helped our understanding of the role of decompressive craniectomy (DC) in adults but no such data is available for the paediatric population. We aim to assess the current literature on the role of DC in this group of patients.
Design Systematic review of this subject.
Subjects 260 paediatric patients within 12 studies were included within our criteria.
Methods A comprehensive search of the MEDLINE and EMBASE databases led to the screening of 212 studies, with 12 studies included. We collected data on age, GCS at presentation, treatment protocols and their short- and long-term outcomes.
Results Nine studies looked at ICP as an outcome and these all reported that it was successfully controlled by DC (69.4%–100% reduction, p<0.05). Only two studies looked at mortality, both found that it was lower in the DC group (p<0.05). The 6–12 month outcome, based on the Extended Glasgow Outcome Scale (GOS-E) and a range of other pre-defined daily activities, were overall positive, or superior to those of medically treated (p<0.05) in 10 of the studies. One study suggested no difference in outcome.
Conclusions The currently available evidence appears to supports the beneficial role of DC in the treatment of children with refractory high ICP (>20 mmHg) and a GCS score of <8 at the time of presentation. However the quality of each of these studies is poor and further research is required.
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