Pereyra, C. Benito Mori, L. Violi, D. Jacintho, P. Segui, G. Losio, D. Lugaro, M. Diaz, G. Strati, J.
Prieto, M. Benavent, G. Schoon, P.
DECOMPRESSIVE CRANIECTOMY AND BRAIN DEATH
Prevalence and Mortality. Eight-Year Retrospective Review.
H.I.G.A Prof. Dr Luis GüemesBuenos Aires, Argentina
H.I.G.A Prof. Dr Luis GüemesBuenos Aires, Argentina
Decompressive craniectomy (DC) is a surgical practice that has been used since the late nineteenth century and that has recently reappeared in daily practice. The main objective of this technique is to avoid the mass effect that leads to transtentorial herniation, brainstem destruction, cardiorespiratory instability and, eventually, to neurological death
OBJECTIVES
1. To assess the prevalence of death based on neurological criteria (DBNC) and the performance of DC in an 8-year period.
2. To compare mortality associated with DC and evolution to DBNC.
INTRODUCTION
MATERIALS & METHODS
A retrospective, observational, cross-sectional study (January 2003-December 2010)
Inclusion criteria: All patients with a Glasgow coma score of ≤ 7 on admission or during their stay in the intensive care unit.
Exclusion criteria: Patients without data of the outcome at discharge.
MATERIALS & METHODS
The data recorded was: sex, age, diagnosis at admission, performance of DC and condition at discharge (discharge or death). In case of death, the fulfillment of DBNC criteria was assessed according to the Argentine National Law 24.193.
Chi square was used for statistical analysis, with a value of significance of < 0.05.
RESULTS
698
patients
711
patients
Death
418 patients
60%
Survived
280 patients
40%
Trauma 335 pts (48%)SAH 122 pts (17%)ICH 125 pts (18%)Ischemic stroke 35 pts (5%)Medical 81 pts (12%)
Excluded13 patients
CATEGORIES
RESULTS Annual Prevalence Rate for DC
2003 2004 2005 2006 2007 2008 2009 20100%
10%
20%
30%
40%
50%
60%
70%
80%
30 %
DC Yes DC No2003 25% 75%2004 37% 63%
2005 22% 78%
2006 28% 72%2007 22% 78%2008 42% 58%2009 28% 72%2010 37% 63%
Chi square for linear trend 4.07 p value 0,043
RESULTS Annual Prevalence Rate for DBCN
1
2
3
4
5
6
7
8
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
2010
2009
2008
2007
2006
2005
2004
2003
16 %
2003 2004 2005 2006 2007 2008 2009 2010
DBCN No 90% 88% 67% 89% 82% 85% 83% 86%
DBCNYes 10% 12% 33% 11% 18% 15% 17% 14%
Chi square for linear trend 0.001 p value 0,97
RESULTS
698
patients
Group DC
206 pts• Death 98 pts (48%)
Group without DC
492 pts• Death 320 pts (65%)
p <0.001, RR 0.73, IC95 0.62-0.86
Mortality
Causes of deathCardiac arrest 270 pts (65%) - DBNC 108 pts (26%)
Excluded 40 pts (9%) not assessed completely for the diagnosis of DBNC
RESULTS Evolution to DBNC
378Patients death
Group DC86 pts
Group without DC
292 pts 84 pts (29%) DBNC
24 pts (28%) DBNC
No significant differences between groups
CONCLUSIONS
High prevalence of DC and better survival were recorded in comparison with the group in which this procedure was not performed.
The prevalence of DBNC was lower than expected in accordance with national registries; however, in this analyzed group, DC did not modify the evolution to DBNC
Thank you for your attention
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