Citation

van Dijck J, Reith F, van Erp I, van Essen T, Maas A, Peul WC, de Ruiter G. J. Neurosurg. Sci. 2018; 62(2): 153-177.

Affiliation

Department of Neurosurgery, Haaglanden Medical Center, The Hague, The Netherlands.

Copyright

(Copyright © 2018, Minerva Medica)

DOI

10.23736/S0390-5616.17.04255-2

PMID

29125266

Abstract

BACKGROUND: Patients presenting with an early GCS score of 3-5 after blunt or penetrating skull-brain assaults are categorized as having sustained a very severe Traumatic Brain Injury (vs-TBI). This category is often overlooked in literature. Impact on patients and families lives however is huge and the question "whether to surgically treat or not" frequently poses a dilemma to treating physicians. Little is known about mortality and outcome, compared to what is known for the group of severe TBI patients (s-TBI) (GCS 3- 8). The main goal of this review is creating more awareness for the neurosurgical treatment of this patient group.

METHODS: A literature search (2000-2017) was conducted discussing 'severe TBI (GCS 3- 8)', '(neuro)surgical management' and 'outcome'. Ultimately 45 out of 2587 articles were included for further analysis.

RESULTS: Mortality rates and unfavourable outcome are high for s-TBI patients and as expected higher for vs-TBI patients. Mortality rates reach up to 100% for specific subgroups with GCS=3 and bilaterally fixed dilated pupils. Functional outcome was generally poor, but sometimes, although seldom, favourable in specific groups of vs-TBI patients after neurosurgical intervention. Factors like initial GCS, pupillary abnormalities and age seem to be associated with worse outcome.

CONCLUSIONS: Overall this literature review showed high rates of unfavourable outcome and mortality for vs-TBI patients. However, some studies, reporting relatively low mortality rates, reported "good" outcome for specific groups of vs-TBI patients. It is concluded that clinical decision making, in particular those on treatment limitations, should never be taken based on the GCS alone.

Language: en