The comparison of prognosis of the patients with severe head trauma in two different treatment protocols

Objective

In several institutions, intraventricular catheter (IVC) placement and decompressive craniectomy (DC) have been included in the treatment protocols of the patients with severe head injury besides the conventional therapies including normoventilation, normothermia, sedation-analgesia and osmotic diuresis. In this study, we compared the mortality and morbidity rates of the patients treated by two different therapy protocols in different periods (conventional therapy group vs conventional + IVC-DC group).

Methods

One hundred and seventeen patients with a Glasgow Coma Scale score ≤ 8 were included in the study. The duration of mechanical ventilation, the ICU stay, surgical procedures, computerised tomography results, and Glasgow Outcome Scores were prospectively recorded. Conventional therapy was performed in 48 patients (Group I) between the years of 1997 and 2000. After 2000, IVC placement and the DC procedure were added to the treatment protocol and 69 patients were treated according to this therapy protocol (Group II).

Results

The groups were similar in terms of age and severity of trauma. In Group I, 16 patients were discharged in good neurological condition (33%), 12 patients in bad neurological condition (25%) and 20 patients (42%) died. In Group II, 34 patients in good neurological condition (49%) and 16 patients in bad neurological condition (23%) were discharged and 19 patients (28%) died (P > 0.05). The mean durations of mechanical ventilation in Group I and Group II were 8.9 ± 7.6 days and 11.8 ± 10.1 days, respectively (P > 0.05). The mean ICU stay was18.1 ± 17.9 days in Group I and 17.8 ± 13.9 days in Group II (P > 0.05).

Conclusion

Although the prognosis of the patients in Group II seemed better than the conventional therapy group, the difference was not statistically significant.