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Evaluation of Outcomes among Patients With Traumatic Intracranial Hypertension Treated With Decompressive Craniectomy vs Standard Medical Care at 24 Months

By Currents Editor posted 10-03-2022 09:19

  

JAMA Neurology (6/06/22) DOI: 10.1001/jamaneurol.2022.1070
Kolias, AG; Adams, H; Timofeev, IS; et al.
https://jamanetwork.com/journals/jamaneurology/article-abstract/2792806 

At 2 years, patients with traumatic intracranial hypertension who underwent a decompressive craniectomy were more likely to improve over time, compared with patients who received standard medical care, according to new research. The prespecified secondary analysis of the Randomized Evaluation of Surgery With Craniectomy for Uncontrollable Elevation of Intracranial Pressure (RESCUEicp) randomized clinical trial involved 408 patients with traumatic intracranial hypertension (>25 mm Hg) from 20 countries. Patients were randomly assigned to receive a decompressive craniectomy with standard care (206) or to ongoing medical treatment with the option to add barbiturate infusion (202). At 24 months post-procedure, patients in the surgical group had lower mortality, at 33.5% vs. 54.0% in the standard care group. The surgical group also had higher rates of vegetative state, lower or upper moderate disability, and lower and upper severe disability. For each 100 patients who underwent decompressive craniectomy, 21 more patients survived at 24 months: 4 were in a vegetative state, 2 had lower and 7 had upper severe disability, and 5 had lower and 3 had upper moderate disability, respectively. The surgical and standard care groups had similar rates of lower and upper good recovery, at 11% and 10.9%, respectively, and there were significant differences noted in net improvement between 6 and 24 months, with respective rates of 30.0% and 14.0%.

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