Predicting outcome in patients with traumatic brain injury who undergo a decompressive craniectomy at a single academic center in Pretoria, South Africa

Aim: South Africa ranks as a global epicenter for traumatic brain injury, a proportion of which results in raised intra-cranial pressure of various degree requiring neurosurgical intervention. We aimed to determine the significance of demographic, pre-operative, operative, and post-operative variables in predicting outcome in 62 patients admitted over a 5-year period with traumatic brain injury and raised intra-cranial pressure who underwent decompressive craniectomy. Methods: Retrospective chart review of 62 patients admitted with traumatic brain injury and raised intra-cranial pressure who underwent decompressive craniectomy from January 2014 to December 2018 was performed. Medical records were analyzed for Age; Gender; Mechanism of injury; Hours between injury and admission; Severity of head injury; Hours between admission and surgery; Type of decompressive craniectomy performed; and Glasgow Outcome Score at discharge. Results: Considering all variables, significance was demonstrated between Mechanism of injury, namely being assaulted which was favorable rather than having fallen or being involved in a motor vehicle or pedestrian vehicle accident which was unfavorable (p = 0.015); Time from injury to neurosurgical admission (p = 0.007), and especially Severity of head injury at admission (p < 0.001) in predicting outcome. Neither Age (p = 0.84); Gender (p = 0.88); CT finding (p = 0.34) or Time from admission to surgery (p = 0.39) demonstrated significance. Conclusion: Considering patients with traumatic brain injury who underwent a decompressive craniectomy, our study noted that all of the variables that demonstrated significance in determining outcome were determined prior to the patient being admitted to our unit. Our study highlights the need for primary prevention of falls, motor vehicle, and pedestrian vehicle accidents as well as early presentation as the major determinants of outcome.