Early versus Late Decompressive Craniectomy in Pediatrics with Traumatic Brain Injuries A Retrospective Study

BACKGROUND: Severe traumatic brain injury (TBI) is a leading cause of mortality and disability in pediatric patients, especially in low-and middle-income countries. TBI significantly impacts child development and incurs substantial health care costs. Management of severe TBI includes evidence-based protocols to prevent and treat increased intracranial pressure (ICP), with decompressive craniectomy (DC) as a rescue measure. This study investigates the role of early DC in improving outcomes for children with severe TBI. METHODS: A retrospective study was conducted from January 2003 to January 2023 at King Abdullah University Hospital, the main tertiary hospital in North Jordan. This study evaluated pediatric patients (under 16 years old) admitted with severe TBI who underwent early DC (within 24 hours). RESULTS: This study of 45 pediatric patients undergoing DC for severe TBI found a male predominance (75.6%) and a mean age of 4.3 years. Favorable outcomes (Glasgow Outcome Score 4_5) were achieved in 67% of cases. Pupillary abnormalities were significantly associated with prognosis (P = 0.004), but surgical timing (<6 vs. >6 hours) was not (P = 0.661). The in-hospital mortality rate was 24%, with complications in 35.6% of patients. ICP monitoring was performed in 26.7% of patients. CONCLUSIONS: DC remains a crucial intervention for pediatric patients with severe TBI, primarily to control ICP. Our study found no significant difference in outcomes between early and late DC, aligning with prior research. However, pupillary abnormalities emerged as a key prognostic factor. Our findings highlight the need for further prospective multicenter studies to refine surgical timing for optimal outcomes.