Decompressive craniectomy in the management of intracranial hypertension after traumatic brain injury: a systematic review and meta-analysis

Abstract We aim to perform a systematic review and meta-analysis to examine the prognostic value of decompressive craniectomy (DC) in patients with traumatic intracranial hypertension. PubMed, EMBASE, Cochrane Controlled Trials Register, Web of Science, http://clinicaltrials.gov/ were searched for e...

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Autores principales:	Danfeng Zhang, Qiang Xue, Jigang Chen, Yan Dong, Lijun Hou, Ying Jiang, Junyu Wang
Formato:	article
Lenguaje:	EN
Publicado:	Nature Portfolio 2017
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/34cb881b69694ac5bfd0d6cf1e45ed55
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spelling	oai:doaj.org-article:34cb881b69694ac5bfd0d6cf1e45ed552021-12-02T15:06:13ZDecompressive craniectomy in the management of intracranial hypertension after traumatic brain injury: a systematic review and meta-analysis10.1038/s41598-017-08959-y2045-2322https://doaj.org/article/34cb881b69694ac5bfd0d6cf1e45ed552017-08-01T00:00:00Zhttps://doi.org/10.1038/s41598-017-08959-yhttps://doaj.org/toc/2045-2322Abstract We aim to perform a systematic review and meta-analysis to examine the prognostic value of decompressive craniectomy (DC) in patients with traumatic intracranial hypertension. PubMed, EMBASE, Cochrane Controlled Trials Register, Web of Science, http://clinicaltrials.gov/ were searched for eligible studies. Ten studies were included in the systematic review, with four randomized controlled trials involved in the meta-analysis, where compared with medical therapies, DC could significantly reduce mortality rate [risk ratio (RR), 0.59; 95% confidence interval (CI), 0.47–0.74, P < 0.001], lower intracranial pressure (ICP) [mean difference (MD), −2.12 mmHg; 95% CI, −2.81 to −1.43, P < 0.001], decrease the length of ICU stay (MD, −4.63 days; 95% CI, −6.62 to −2.65, P < 0.001) and hospital stay (MD, −14.39 days; 95% CI, −26.00 to −2.78, P = 0.02), but increase complications rate (RR, 1.94; 95% CI, 1.31–2.87, P < 0.001). No significant difference was detected for Glasgow Outcome Scale at six months (RR, 0.85; 95% CI, 0.61–1.18, P = 0.33), while in subgroup analysis, early DC would possibly result in improved prognosis (P = 0.04). Results from observational studies supported pooled results except prolonged length of ICU and hospital stay. Conclusively, DC seemed to effectively lower ICP, reduce mortality rate but increase complications rate, while its benefit on functional outcomes was not statistically significant.Danfeng ZhangQiang XueJigang ChenYan DongLijun HouYing JiangJunyu WangNature PortfolioarticleMedicineRScienceQENScientific Reports, Vol 7, Iss 1, Pp 1-10 (2017)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Danfeng Zhang Qiang Xue Jigang Chen Yan Dong Lijun Hou Ying Jiang Junyu Wang Decompressive craniectomy in the management of intracranial hypertension after traumatic brain injury: a systematic review and meta-analysis
description	Abstract We aim to perform a systematic review and meta-analysis to examine the prognostic value of decompressive craniectomy (DC) in patients with traumatic intracranial hypertension. PubMed, EMBASE, Cochrane Controlled Trials Register, Web of Science, http://clinicaltrials.gov/ were searched for eligible studies. Ten studies were included in the systematic review, with four randomized controlled trials involved in the meta-analysis, where compared with medical therapies, DC could significantly reduce mortality rate [risk ratio (RR), 0.59; 95% confidence interval (CI), 0.47–0.74, P < 0.001], lower intracranial pressure (ICP) [mean difference (MD), −2.12 mmHg; 95% CI, −2.81 to −1.43, P < 0.001], decrease the length of ICU stay (MD, −4.63 days; 95% CI, −6.62 to −2.65, P < 0.001) and hospital stay (MD, −14.39 days; 95% CI, −26.00 to −2.78, P = 0.02), but increase complications rate (RR, 1.94; 95% CI, 1.31–2.87, P < 0.001). No significant difference was detected for Glasgow Outcome Scale at six months (RR, 0.85; 95% CI, 0.61–1.18, P = 0.33), while in subgroup analysis, early DC would possibly result in improved prognosis (P = 0.04). Results from observational studies supported pooled results except prolonged length of ICU and hospital stay. Conclusively, DC seemed to effectively lower ICP, reduce mortality rate but increase complications rate, while its benefit on functional outcomes was not statistically significant.
format	article
author	Danfeng Zhang Qiang Xue Jigang Chen Yan Dong Lijun Hou Ying Jiang Junyu Wang
author_facet	Danfeng Zhang Qiang Xue Jigang Chen Yan Dong Lijun Hou Ying Jiang Junyu Wang
author_sort	Danfeng Zhang
title	Decompressive craniectomy in the management of intracranial hypertension after traumatic brain injury: a systematic review and meta-analysis
title_short	Decompressive craniectomy in the management of intracranial hypertension after traumatic brain injury: a systematic review and meta-analysis
title_full	Decompressive craniectomy in the management of intracranial hypertension after traumatic brain injury: a systematic review and meta-analysis
title_fullStr	Decompressive craniectomy in the management of intracranial hypertension after traumatic brain injury: a systematic review and meta-analysis
title_full_unstemmed	Decompressive craniectomy in the management of intracranial hypertension after traumatic brain injury: a systematic review and meta-analysis
title_sort	decompressive craniectomy in the management of intracranial hypertension after traumatic brain injury: a systematic review and meta-analysis
publisher	Nature Portfolio
publishDate	2017
url	https://doaj.org/article/34cb881b69694ac5bfd0d6cf1e45ed55
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Decompressive craniectomy in the management of intracranial hypertension after traumatic brain injury: a systematic review and meta-analysis

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