| META ANALYSIS
|Year : 2019 | Volume
| Issue : 5 | Page : 1225--1232
Role of Decompressive Craniectomy in Traumatic Brain Injury – A Meta-analysis of Randomized Controlled Trials
Kanwaljeet Garg1, Preet M Singh2, Raghav Singla1, Ankita Aggarwal3, Anuradha Borle2, Manmohan Singh1, P Sarat Chandra1, Shashank S Kale1, Ashok K Mahapatra1
1 Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
2 Department of Anaesthesia, All India Institute of Medical Sciences, New Delhi, India
3 Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
Objective: Several studies have indicated that decompressive craniectomy (DC) for traumatic brain injury (TBI) is lifesaving. However, there is lack of level 1 evidence to define the role of DC in TBI. We performed a meta-analysis of all the randomized controlled trials (RCTs) published so far on the role of DC in adult patients with TBI.
Materials and Methods: A systematic literature search was performed for articles published until September of 2016 for RCTs of DC in adult patients with TBI. The primary end-point was mortality at six-months. We also evaluated the overall adverse outcomes at six months. Assessment of risk of bias of the RCTs was also performed.
Results: Three trials evaluating adult population satisfied the eligibility criteria. Pooled analysis involved 285 and 288 patients in DC group and control groups respectively. Patients undergoing DC for TBI had a lower mortality association of nearly 50 percent. However, patients surviving DC were more likely to have a poor neurological outcome compared to patients undergoing medical management.
Conclusion: Based on the available RCTs on DC in TBI, the results of our meta-analysis show that there is a mortality benefit of performing a DC over the best medical management in adult patients. Furthermore, surviving following DC, a greater incidence of a poor neurological outcome is noted. In the event of small number of high-quality RCTs, our results must be interpreted with caution.
Dr. Kanwaljeet Garg
Room No. 716, Cardio-Neuro Centre, All India Institute of Medical Sciences, New Delhi
Source of Support: None, Conflict of Interest: None
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