ArticleEuropean journal of trauma and emergency surgery : official publication of the European Trauma Society2025
Primary versus secondary decompressive craniectomy in traumatic brain injury: analysis of the indications and outcomes.
Article in European journal of trauma and emergency surgery : official publication of the European Trauma Society, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
1 citing paper in PubMed.
- Severe trauma care: advances and future directions in diagnostic and therapeutic techniques and information technology support.Medical review (2021) · 2026Article
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Authors and funding
6 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeDecompressive craniectomy (DC) reduces mortality in traumatic brain injury (TBI), but its impact on functional outcomes remains debated. DC is classified as primary or secondary; however, most studies analyze both together. This study aims to compare clinical and epidemiological differences between primary and secondary DC.
methodsA retrospective cohort study analyzed severe TBI patients requiring primary vs. secondary DC admitted to our Intensive Care Unit (ICU) (2014-2024). Epidemiological, clinical, and radiological variables were evaluated.
resultsAmong 312 ICU-admitted TBI patients, 72 underwent DC (45 primary, 33 secondary). Primary DC was performed intraoperatively during mass evacuation without prior intracranial pressure (ICP) assessment, while secondary DC was performed for refractory intracranial hypertension (ICH). Patients who underwent primary DC showed signs of more severe injury at admission, which was associated with higher mortality.
conclusionSecondary DC patients had a better initial prognosis and ICU course, likely due to the selection of less severe cases. Higher mortality in the primary DC group may reflect the greater severity of the initial injury rather than the negative impact of early intervention. A predictive model incorporating clinical (hemodynamic instability) and radiological (perimesencephalic cistern collapse, midline shift) criteria effectively differentiates primary DC candidates (AUC = 0.821, p < 0.0001).
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