Objectives The RESCUEicp study has not culminated in consensus about the role of decompressive craniectomy following head injury. Another study (RESCUE-ASDH) also questions craniectomy for patients with ASDH. We examined our own practice over 5 years.

Design Retrospective analysis at a single UK unit. Comparison of outcomes with RESCUEicp results and national data obtained from the Neurosurgical National Audit Programme (NNAP).

Subjects 82 patients over 5 years. 87% male. 90% adults (age >16).

Methods Local data: demographics, CT features, pre-op GCS/pupil reaction/ICP, primary/secondary craniectomy, operative timings, length of stay (critical care/overall), Extended Glasgow Outcome Scores, discharge location. NNAP data analysis.

Results 43% had ASDH with MLS >5 mm (91% primary decompression). Median time to primary surgery from referral 1 h37. 11 primary, 6 secondary decompressions/year; no change over 5 years 3 extensions of craniectomy, 3 had previous craniotomy converted. 30 day mortality 28%. Overall GOS-E: death 33%, lower severe disability 6%, upper severe disability 6%, moderate disability 16%, good recovery 37% (improved by better presentation GCS). 75% had cranioplasty. Median length of stay 41 days.

Conclusions Our practice has not changed over time, despite RESCUEicp. Good outcomes observed may be due to local specialist management of these patients, or reflect judicious case selection. Case-by-case decisions are crucial and may explain why large trials fail to change real-world management strategies. NNAP data comparison ongoing.