Cranioplasty as a surrogate marker for excellent outcome in severe head injury

Abstract

Outcome in severe head injury is difficult to assess due to lack of follow up. Operated patients who return for cranioplasty usually have the best outcome. The aim of this study was to assess outcome following severe head injury using cranioplasty as a surrogate marker. This was a retrospective study carried out from November 2008 to March 2010. All patients with severe head injury who underwent decompressive craniectomy (DC) or cranioplasty in the study period were included. Case records, imaging and follow up visit data from all patients were reviewed. Glasgow Coma Score on admission and Glasgow Outcome Score at discharge were assessed.

Of the 273 patients, 84.25% (n=230) were male and 15.75% (n=43) were female. The mean age was 34.3 years (range 2–81 years SD 16.817). The mean GCS on admission was 5.615 (range 3–8, SD 1.438). The in-hospital mortality was 54% (n=149). GOS of 4 or 5 at discharge was attained in 22% (n=60) patients. Sixty five patients returned for cranioplasty during follow up. The M:F ratio (6.2:1) matched with the study cohort. However, the difference in mean age (28.815 years SD 13.396) and mean GCS on first admission of 6.323 (SD 1.393) were statistical significant. Therefore, at the very minimum, 65 patients (24%) of the study cohort had excellent outcome. In operated severe head injury patients significant number of patients (24% in our study) have excellent outcome. Also, cranioplasty can serve as a useful marker to assess outcome of operated severe head injury patients in an institution.

Keywords

cranioplasty - outcome - severe head injury

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