Role of Decompressive Craniectomy in the Management of Traumatic Brain Injury - A Meta-Analysis of Randomized Controlled Trials

Traumatic brain injury (TBI) is a serious medical condition that often leads to significant morbidity and mortality. Decompressive craniectomy (DC) is now widely recognized as a primary or secondary treatment option for managing intracranial pressure (ICP) in patients with severe TBI. However, there is a lack of clarity in reviews regarding the impact of DC on TBI outcomes. The aim of this study is to evaluate the effectiveness of DC in terms of overall mortality and long-term prognosis among patients with TBI. We conducted a systematic search of four common databases to include all parallel-arm randomized controlled trials (RCTs). We selected studies that reported outcomes for TBI cases, with DC as a treatment option. The outcomes examined included reduction in mortality, ICP levels, and the proportion of patients with a Glasgow Outcome Scale score >4. Our review finally included eight RCTs [n = 1458, with 749 and 709 patients in the DC and control groups, respectively]. The weighted mean difference for ICP was estimated at -4.01 (95% Confidence interval [CI -5.31–-2.71), indicating a statistically significant reduction in ICP levels in the DC group compared to the control group. The pooled risk ratio was 0.67 (95% CI 0.51–0.89), suggesting a statistically significant 31% decrease in mortality levels in the DC group. Subgroup and sensitivity analyzes were also conducted to address heterogeneity. In conclusion, based on our meta-analysis, we find that DC can be considered a crucial surgical intervention for reducing mortality among patients with TBI when compared to control groups.