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General Critical Care

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Craniotomy vs. Decompressive Craniectomy for Traumatic Acute Subdural Hematoma

1) What was the research question? The researchers wanted to know whether craniotomy or decompressive craniectomy would lead to better outcomes for patients undergoing surgery for traumatic acute subdural hematoma.

2) How did they do it? They randomly assigned patients to undergo either craniotomy or decompressive craniectomy. They evaluated the patients' outcomes using the Extended Glasgow Outcome Scale (GOSE) at 6 and 12 months, as well as the EuroQol Group 5-Dimension 5-Level questionnaire (EQ-5D-5L) to assess quality of life.

3) What were the results? They had 450 patients in total, with 228 in the craniotomy group and 222 in the decompressive craniectomy group. The analysis showed no significant difference in outcomes between the two groups at 6 and 12 months. The rates of death, vegetative state, and good recovery were similar, although the craniectomy group had slightly lower rates of good recovery. Quality of life scores were also similar between the groups. Additional cranial surgeries were more common in the craniotomy group, while wound complications were higher in the craniectomy group.

4) What does it mean? The choice between craniotomy and decompressive craniectomy doesn't seem to make much of a difference in terms of outcomes for patients with traumatic acute subdural hematoma. Both procedures have their pros and cons, with additional surgeries being more common in the craniotomy group and wound complications being more prevalent in the craniectomy group. Clinicians can take these factors into consideration when deciding on the appropriate surgical approach for their patients.

Decompressive Craniectomy versus Craniotomy for Acute Subdural Hematoma | NEJM

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