Traumatic brain injury (TBI) is a worldwide major health problem associated with a high rate of morbidity and mortality. Intracranial hypertension following TBI is the main but not the only cause of early mortality. Decompressive craniectomy (DC) is used to decrease the intracranial pressure (ICP) and prevent brain herniation following TBI; however, the clinical outcome after DC for patients with TBI generates continuous debate. Prediction of early mortality after DC will help in making the surgery decision. The aim of this study is to predict early mortality after DC based on the initial clinical and radiological findings. In this study, 104 patients with severe traumatic brain injury have been treated by decompressive craniectomy and were retrospectively analyzed. Patients were divided into two groups; group I involved 32 patients who died within 28 days while group II involved 72 patients who survived after 28 days. The relationship between initial Glasgow Coma Scale score (GCS), pupil size and reactivity, associated injuries, and radiological findings were analyzed as predictor factors for early mortality. A total of 104 patients with severe TBI have been treated by DC and were analyzed; the early mortality occurred in 32 patients, 30.77%. There is a significant difference between groups in gender, mean GCS, Marshall scale, presence of isochoric pupils, and lung injury. After stratification, odds of early mortality increases with the lower GCS, higher Marshall scale, lung injury, and abdominal injury while male gender and the presence of isochoric pupils decrease the odds of mortality. After univariate regression, the significant impact of GCS disappears except for GCS-8 which decreases the odds of mortality in comparison to other GCS scores while higher Marshall scale, presence of isochoric pupils, and lung injury increase the odds of mortality, but most of these effects disappear after multiple regressions except for lung injury and isochoric pupils. Prediction of early mortality after DC is multifactorial, but the odds of early mortality after decompressive craniectomy in severe traumatic brain injury are progressively increased with the lower GCS, higher Marshall scale, and the presence of lung or abdominal injury.

中文翻译：

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重型颅脑外伤患者初次减压颅骨切除术后早期死亡率的预测

颅脑外伤（TBI）是世界范围内的重大健康问题，与高发病率和高死亡率相关。TBI后颅内高压是早期死亡的主要原因，但不是唯一的原因。减压颅骨切除术（DC）用于降低颅内压（ICP）并防止TBI后脑疝。然而，DC对TBI患者的临床结局引起了持续的争论。DC术后早期死亡率的预测将有助于做出手术决策。这项研究的目的是根据最初的临床和放射学发现预测DC术后的早期死亡率。在这项研究中，对104例重度颅脑外伤患者进行了减压颅骨切除术治疗，并进行了回顾性分析。患者分为两组。第一组涉及在28天内死亡的32例患者，而第二组涉及在28天内存活的72例患者。最初的格拉斯哥昏迷量表评分（GCS），瞳孔大小和反应性，相关伤害以及放射学结果之间的关系作为早期死亡的预测因素进行了分析。共有104例重度TBI患者已接受DC治疗并进行了分析；早期死亡发生32例，占30.77％。性别，平均GCS，马歇尔量表，等速瞳孔的存在和肺损伤之间在组之间存在显着差异。分层后，早期死亡的几率随着较低的GCS，较高的马歇尔规模，肺损伤和腹部损伤而增加，而男性和等速瞳孔的存在降低了死亡几率。单变量回归后，GCS的重要影响消失了，除了GCS-8与其他GCS分数相比降低了死亡率的可能性，而更高的马歇尔量表，等速瞳孔的存在和肺损伤增加了死亡率的可能性，但是大多数这些影响在多次发作后消失除肺部损伤和瞳孔等速瞳孔外，其余均回归。DC术后早期死亡率的预测是多因素的，但是随着GCS降低，Marshall评分较高以及肺或腹部损伤的存在，严重颅脑损伤减压颅骨切除术后早期死亡的几率逐渐增加。但是除了肺部损伤和瞳孔等速瞳孔外，这些影响中的大多数在多重回归后都消失了。DC术后早期死亡率的预测是多因素的，但是随着GCS降低，Marshall评分较高以及肺或腹部损伤的存在，严重颅脑损伤减压颅骨切除术后早期死亡的几率逐渐增加。但是除了肺部损伤和瞳孔等速瞳孔外，这些影响中的大多数在多重回归后都消失了。DC术后早期死亡率的预测是多因素的，但是随着GCS降低，Marshall评分较高以及肺或腹部损伤的存在，严重颅脑损伤减压颅骨切除术后早期死亡的几率逐渐增加。