796: PEDIATRIC LONG-TERM OUTCOME WITH DECOMPRESSIVE CRANIECTOMY AFTER SEVERE TRAUMATIC BRAIN INJURY

Abstract

Learning Objectives: Decompressive craniectomy (DC) has been used for refractory intracranial hypertension with the objective of maintaining brain perfusion and improving outcomes. However, researches have been controversial and limited on pediatric population. This project aims to determine the profile of severe traumatic brain injury (STBI) in Puerto Rico and compare between with and no DC, evaluating outcome of longterm post trauma. Our hypothesis is that children with DC will have greater disability. Methods: In this case-control observational study, we identified patients admitted in our pediatric critical care unit for STBI, June 2016 October 2018. Patients >21years, mortality in less than 24hrs, no intracranial pressure monitoring, no interview consent and previous disability were excluded. Clinical variables include intracranial pressure (mmHg), cerebral perfusion pressure, mean arterial pressure, serum sodium levels and pressure oxygen level. Data represents the first 24hrs of management. DC date/time, length of stay, mechanical ventilation (MV) days, were abstracted from the record. Outcome measured with Glasgow Outcome Scale-Extended Pediatric version (GOES-P) via phone interview up to 2 years after trauma. The data is expressed as medians +/Standard Deviation, interquartile range (IQR) or percentages as appropriate. Mann Whitney test used to compare between DC group. A p-value ≤ 0.05 considered statistically significant. Results: 11 patients met inclusion criteria, 3 Females (27%), 8 Males (73%). Median age 14 years {+/-5.1} (9,16): median {+/SD} (IQR). Glasgow Coma Scale, median of 3 {+1.9} (3,6). No DC 4 and with DC 7 (36.4% vs 63.6%). Mortality of 1 (9%, unit 3.1%). Inotropes used in 54% of patients and hyperosmolar therapy in 92%. Hospital length of stay was significantly longer in the DC group p=0.006. We observe a longer tendency on the MV days in the DC group (p=0.06). 8 caretakers completed the GOES-P interview. GOES-P between no DC 2, median 3 {+/-2.8} (1,5) and DC 6, median 3 {+/-2.2} (1,6), did not demonstrate a difference in outcome p=0.71. Conclusions: We found a significant difference in longer hospital stay and a tendency of more MV days in the DC group. This result added comorbidity to the DC group that may have influenced in finding no neurological benefits from a DC procedure.