Outcomes of decompressive craniectomy in adults with severe traumatic brain injury: the Groote Schuur Hospital experience

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dc.contributor.advisorSemple, P Len_ZA
dc.contributor.authorEnslin, Johannes Marthinus Nicolaasen_ZA
dc.date.accessioned2015-06-26T11:03:31Z
dc.date.available2015-06-26T11:03:31Z
dc.date.issued2014en_ZA
dc.descriptionIncludes bibliographical references.en_ZA
dc.description.abstractObject: The aim of this study was to assess outcome following decompressive craniectomy in adults with severe traumatic brain injury (TBI) in a South African neurosurgical unit. Methods: During a 78 month period (January 2005 – June 2011), 76 patients that underwent decompressive craniectomy for TBI in an attempt to lower raised intracranial pressure (ICP) were reviewed . All were older than 14 years and mass lesions were included. Thirty nine point four percent of the patients sustained blunt, low velocity injuries to the head and 19% were involved in motor vehicle accidents. Unilateral hemi-craniectomies were carried out in 81% of patients and 54 (75%) were done as primary decompressive craniectomies. Survivors were followed up for a period of at least six months and functional outcomes were measured using the Glasgow outcomes score. To simplify outcomes the patients were then dichotomised into outcome groups of good (GOS 4 and 5 ), and poor (GOS 1- 3). Results: At six months follow up 24 patients (33.3%) had a good outcome (GOS 4 or 5) and 48 patients (66.7%) had a poor outcome (GOS 1- 3). 32 patients (44.4%) died (GOS 1). There were 16 survivors in the poor group. Sixty percent o f survivors had a good outcome after decompressive craniectomy. Eighteen patients underwent secondary decompressive craniectomies and 54 (75%) primary decompressive craniectomies. Thirty - five percent of patients that underwent primary decompressive cranie ctomy had a good outcome, versus 38% in the secondary decompression group. Mortality was slightly higher in the primary decompression group (43%) than the secondary group (33%) . Factors that showed significant correlation with outcome were age, admission GCS and good response of ICP to decompressive craniectomy. Complications were encountered in 18% of patients with sepsis being the most common (11%). Conclusion: Decompressive craniectomy was associated with a functional outcome that was better than exp ected in patients with severe TBI and should still form part of salvage therapy in adults with TBI and elevated ICP.en_ZA
dc.identifier.apacitationEnslin, J. M. N. (2014). <i>Outcomes of decompressive craniectomy in adults with severe traumatic brain injury: the Groote Schuur Hospital experience</i>. (Thesis). University of Cape Town ,Faculty of Health Sciences ,Division of Neurosurgery. Retrieved from http://hdl.handle.net/11427/13110en_ZA
dc.identifier.chicagocitationEnslin, Johannes Marthinus Nicolaas. <i>"Outcomes of decompressive craniectomy in adults with severe traumatic brain injury: the Groote Schuur Hospital experience."</i> Thesis., University of Cape Town ,Faculty of Health Sciences ,Division of Neurosurgery, 2014. http://hdl.handle.net/11427/13110en_ZA
dc.identifier.citationEnslin, J. 2014. Outcomes of decompressive craniectomy in adults with severe traumatic brain injury: the Groote Schuur Hospital experience. University of Cape Town.en_ZA
dc.identifier.ris TY - Thesis / Dissertation AU - Enslin, Johannes Marthinus Nicolaas AB - Object: The aim of this study was to assess outcome following decompressive craniectomy in adults with severe traumatic brain injury (TBI) in a South African neurosurgical unit. Methods: During a 78 month period (January 2005 – June 2011), 76 patients that underwent decompressive craniectomy for TBI in an attempt to lower raised intracranial pressure (ICP) were reviewed . All were older than 14 years and mass lesions were included. Thirty nine point four percent of the patients sustained blunt, low velocity injuries to the head and 19% were involved in motor vehicle accidents. Unilateral hemi-craniectomies were carried out in 81% of patients and 54 (75%) were done as primary decompressive craniectomies. Survivors were followed up for a period of at least six months and functional outcomes were measured using the Glasgow outcomes score. To simplify outcomes the patients were then dichotomised into outcome groups of good (GOS 4 and 5 ), and poor (GOS 1- 3). Results: At six months follow up 24 patients (33.3%) had a good outcome (GOS 4 or 5) and 48 patients (66.7%) had a poor outcome (GOS 1- 3). 32 patients (44.4%) died (GOS 1). There were 16 survivors in the poor group. Sixty percent o f survivors had a good outcome after decompressive craniectomy. Eighteen patients underwent secondary decompressive craniectomies and 54 (75%) primary decompressive craniectomies. Thirty - five percent of patients that underwent primary decompressive cranie ctomy had a good outcome, versus 38% in the secondary decompression group. Mortality was slightly higher in the primary decompression group (43%) than the secondary group (33%) . Factors that showed significant correlation with outcome were age, admission GCS and good response of ICP to decompressive craniectomy. Complications were encountered in 18% of patients with sepsis being the most common (11%). Conclusion: Decompressive craniectomy was associated with a functional outcome that was better than exp ected in patients with severe TBI and should still form part of salvage therapy in adults with TBI and elevated ICP. DA - 2014 DB - OpenUCT DP - University of Cape Town LK - https://open.uct.ac.za PB - University of Cape Town PY - 2014 T1 - Outcomes of decompressive craniectomy in adults with severe traumatic brain injury: the Groote Schuur Hospital experience TI - Outcomes of decompressive craniectomy in adults with severe traumatic brain injury: the Groote Schuur Hospital experience UR - http://hdl.handle.net/11427/13110 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/13110
dc.identifier.vancouvercitationEnslin JMN. Outcomes of decompressive craniectomy in adults with severe traumatic brain injury: the Groote Schuur Hospital experience. [Thesis]. University of Cape Town ,Faculty of Health Sciences ,Division of Neurosurgery, 2014 [cited yyyy month dd]. Available from: http://hdl.handle.net/11427/13110en_ZA
dc.language.isoengen_ZA
dc.publisher.departmentDivision of Neurosurgeryen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.subject.otherNeurosurgeryen_ZA
dc.titleOutcomes of decompressive craniectomy in adults with severe traumatic brain injury: the Groote Schuur Hospital experienceen_ZA
dc.typeMaster Thesis
dc.type.qualificationlevelMasters
dc.type.qualificationnameMMeden_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceThesisen_ZA
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