Role of decompressive craniectomy in the management of traumatic brain injury - A meta-analysis of randomized controlled trials
Background: Traumatic brain injury (TBI) is a serious medical condition that often leads to significant morbidity and mortality. Decompressive craniectomy (DC) is now widely recognized as a primary or secondary treatment option for managing intracranial pressure (ICP) in patients with severe TBI. Ho...
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Medknow Publications
2023-01-01
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| Series: | Annals of Indian Academy of Neurology |
| Subjects: | |
| Online Access: | http://www.annalsofian.org/article.asp?issn=0972-2327;year=2023;volume=26;issue=6;spage=966;epage=974;aulast=Zhang |
| _version_ | 1797352304826908672 |
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| author | Qiang Zhang Yuhuan Li Xiaozan Chang |
| author_facet | Qiang Zhang Yuhuan Li Xiaozan Chang |
| author_sort | Qiang Zhang |
| collection | DOAJ |
| description | Background: Traumatic brain injury (TBI) is a serious medical condition that often leads to significant morbidity and mortality. Decompressive craniectomy (DC) is now widely recognized as a primary or secondary treatment option for managing intracranial pressure (ICP) in patients with severe TBI. However, there is a lack of clarity in reviews regarding the impact of DC on TBI outcomes. Objectives: The aim of this study is to evaluate the effectiveness of DC in terms of overall mortality and long-term prognosis among patients with TBI. Materials and Methods: We conducted a systematic search of four common databases to include all parallel-arm randomized controlled trials (RCTs). We selected studies that reported outcomes for TBI cases, with DC as a treatment option. The outcomes examined included reduction in mortality, ICP levels, and the proportion of patients with a Glasgow Outcome Scale score >4. Results: Our review finally included eight RCTs [n = 1458, with 749 and 709 patients in the DC and control groups, respectively]. The weighted mean difference for ICP was estimated at -4.01 (95% Confidence interval [CI]: -5.31–-2.71), indicating a statistically significant reduction in ICP levels in the DC group compared to the control group. The pooled risk ratio was 0.67 (95% CI: 0.51–0.89), suggesting a statistically significant 31% decrease in mortality levels in the DC group. Subgroup and sensitivity analyzes were also conducted to address heterogeneity. Discussion and Conclusion: In conclusion, based on our meta-analysis, we find that DC can be considered a crucial surgical intervention for reducing mortality among patients with TBI when compared to control groups. |
| first_indexed | 2024-03-08T13:14:34Z |
| format | Article |
| id | doaj.art-9f2bc12e10cd4f72bc73b4baf0ad8b0a |
| institution | Directory Open Access Journal |
| issn | 0972-2327 1998-3549 |
| language | English |
| last_indexed | 2024-03-08T13:14:34Z |
| publishDate | 2023-01-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Annals of Indian Academy of Neurology |
| spelling | doaj.art-9f2bc12e10cd4f72bc73b4baf0ad8b0a2024-01-18T10:33:01ZengWolters Kluwer Medknow PublicationsAnnals of Indian Academy of Neurology0972-23271998-35492023-01-0126696697410.4103/aian.aian_432_23Role of decompressive craniectomy in the management of traumatic brain injury - A meta-analysis of randomized controlled trialsQiang ZhangYuhuan LiXiaozan ChangBackground: Traumatic brain injury (TBI) is a serious medical condition that often leads to significant morbidity and mortality. Decompressive craniectomy (DC) is now widely recognized as a primary or secondary treatment option for managing intracranial pressure (ICP) in patients with severe TBI. However, there is a lack of clarity in reviews regarding the impact of DC on TBI outcomes. Objectives: The aim of this study is to evaluate the effectiveness of DC in terms of overall mortality and long-term prognosis among patients with TBI. Materials and Methods: We conducted a systematic search of four common databases to include all parallel-arm randomized controlled trials (RCTs). We selected studies that reported outcomes for TBI cases, with DC as a treatment option. The outcomes examined included reduction in mortality, ICP levels, and the proportion of patients with a Glasgow Outcome Scale score >4. Results: Our review finally included eight RCTs [n = 1458, with 749 and 709 patients in the DC and control groups, respectively]. The weighted mean difference for ICP was estimated at -4.01 (95% Confidence interval [CI]: -5.31–-2.71), indicating a statistically significant reduction in ICP levels in the DC group compared to the control group. The pooled risk ratio was 0.67 (95% CI: 0.51–0.89), suggesting a statistically significant 31% decrease in mortality levels in the DC group. Subgroup and sensitivity analyzes were also conducted to address heterogeneity. Discussion and Conclusion: In conclusion, based on our meta-analysis, we find that DC can be considered a crucial surgical intervention for reducing mortality among patients with TBI when compared to control groups.http://www.annalsofian.org/article.asp?issn=0972-2327;year=2023;volume=26;issue=6;spage=966;epage=974;aulast=Zhangdecompressive craniectomyintracranial pressuremeta-analysismortalitytraumatic brain injury |
| spellingShingle | Qiang Zhang Yuhuan Li Xiaozan Chang Role of decompressive craniectomy in the management of traumatic brain injury - A meta-analysis of randomized controlled trials Annals of Indian Academy of Neurology decompressive craniectomy intracranial pressure meta-analysis mortality traumatic brain injury |
| title | Role of decompressive craniectomy in the management of traumatic brain injury - A meta-analysis of randomized controlled trials |
| title_full | Role of decompressive craniectomy in the management of traumatic brain injury - A meta-analysis of randomized controlled trials |
| title_fullStr | Role of decompressive craniectomy in the management of traumatic brain injury - A meta-analysis of randomized controlled trials |
| title_full_unstemmed | Role of decompressive craniectomy in the management of traumatic brain injury - A meta-analysis of randomized controlled trials |
| title_short | Role of decompressive craniectomy in the management of traumatic brain injury - A meta-analysis of randomized controlled trials |
| title_sort | role of decompressive craniectomy in the management of traumatic brain injury a meta analysis of randomized controlled trials |
| topic | decompressive craniectomy intracranial pressure meta-analysis mortality traumatic brain injury |
| url | http://www.annalsofian.org/article.asp?issn=0972-2327;year=2023;volume=26;issue=6;spage=966;epage=974;aulast=Zhang |
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