For severe traumatic brain injury (sTBI) patients with bilateral fixed dilated pupils (BFDP), the value of aggressively decompressive craniectomy (DC) treatment is still controversial. The objective of this study was to analyze and validate the outcome of DC in sTBI patients with BFDP.
We retrospectively collected data from 44 sTBI patients with BFDP and underwent DC treatment during time period of July 2011 to June 2018. Outcomes used as indicators were mortality and favorable outcome. The analysis was based on the Glasgow Outcome Scale recorded at discharge, 6 and 12 months after trauma.
The overall survival rate was 36.4% (16/44) at discharge and 25.0% (11/44) at 6 and 12 months, and the favorable outcome (GOS = 4-5) at discharge, 6 and 12 months after injury was 9.1% (4/44), 13.6% (6/44) and 20.5% (9/44), respectively. Sex (p = 0.046), pre-operation GCS (p = 0.031), injury-surgery intervals (p = 0.022) and tracheotomy (p = 0.017) were independent associations to 6 and 12 months follow-up survival rate, while only pre-operation GCS (OR=6.088, CI= 1.172-31.612; p = 0.032) and injury-surgery intervals (OR = 0.241, CI = 0.065-0.893; p = 0.033) were independent associations to 12 months follow-up favorable outcome.
BFDP indicates a grave prognostic sign following sTBI, but the higher pre-operation GCS score and shorter injury-surgery intervals underwent DC treatment might independently predicting favorable outcome for sTBI patients with BFDP, and patients might be benefit much more than we thought if the DC treatment been applied more aggressively and positively.

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