Article
Decompressive craniectomy is associated with better quality of life up to ten years following traumatic brain injury
Dekompressionskraniektomie ist mit verbesserter Lebensqualität bis 10 Jahre nach Schädel-Hirntrauma assoziiert
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Published: | May 8, 2019 |
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Objective: Decompressive craniectomy (DC) successfully prevents secondary brain injury and improves quality of life (QoL) after malignant ischemic stroke. But, DC following TBI did not improve functional outcome at 6 months. Thus, DC is not the first-line recommendation after TBI although very little is known about its long-term effects. Hence, we assessed health-related quality of life (HRQoL) in TBI patients with or without having received DC.
Methods: In this cross-sectional study, a representative sample of 135 out of 439 patients reported HRQoL up to 10 years after mild, moderate or severe TBI using the QOLIBRI questionnaire (Quality of Life after Brain Injury) with a total score of 0–100 representing lowest and best HRQoL, respectively. HRQoL was quantified (%; mean ±SD) and correlated to TBI severity, etiology, age at TBI, age at survey, sex, DC, ICP monitoring, tracheostomy, time to onset and duration of neurorehabilitation, and functional status (mobile/immobile: mRS 0–3/mRS 4–5) at admission/discharge (%) using multiple linear regression via backward selection. Numerical and categorical variables were analyzed using Wilcoxon-Mann-Whitney and Fisher test, respectively.
Results: TBI severity is not a strong predictor for HRQoL in the entire cohort (p=0.04; adj. R2=0.02). 30% of TBI patients (n=41) underwent DC. 59% of non-craniectomized (DC-) and 76% of craniectomized patients (DC+) reported good HRQoL with a median QOLIBRI total score of 65 in DC- and 76 in DC+ patients (p=0.049). The most beneficial effect was observed in initially mild classified, but immobile TBI patients at admission to neurorehabilitation (mean mRS of 4) with a QOLIBRI total score of 54 (DC-) and 84 (DC+) (p=0.001; adj. R2=0.45), during the first year after TBI with a score of 50 (DC-) and 76 (DC+) (p=0.13), and in the 61–85-year-olds with a score of 62 (DC-) and 79 (DC+), respectively (p=0.02). Risk for one or even two psychiatric comorbidities differed between DC- and DC+ groups: 22% (DC-) versus 15% (DC+) and 18% (DC-) versus 9% (DC+), respectively.
Conclusion: Decompressive craniectomy is associated with better HRQoL and reduced risk for psychiatric sequels up to 10 years after TBI. DC particularly improves HRQoL in those patients being prone to secondary brain injury and in the elderly. Thus, our data underline the relevance of DC for good long-term outcome following TBI and the need for an early psychiatric approach to improve HRQoL in chronic TBI patients.