Investigating Pre-operative Factors Which Influence Functional Outcomes in Traumatic Brain Injury Patients Undergoing Decompressive Craniectomy: A Systematic Literature Review

Foytl, J., Varsou, O. and McKinley, M. (2019) Investigating Pre-operative Factors Which Influence Functional Outcomes in Traumatic Brain Injury Patients Undergoing Decompressive Craniectomy: A Systematic Literature Review. Glasgow Neuro Conference 2019, Glasgow, UK, 09 Nov 2019.

Abstract

Introduction: Traumatic brain injury (TBI) is a global issue which affects millions of people and often leaves lasting consequences. Decompressive craniectomy (DC) is a surgical approach for TBI with varied outcomes. Some patients make excellent functional recovery, while others survive with severe disability or fail to recover. If links between pre-operative factors and outcomes are better delineated, clinicians will be better placed to identify patients who are most likely to benefit from DC. By systematically and critically analysing relevant literature, this work aims to identify pre-operative factors linked to better functional outcomes in patients who have undergone DC, resulting in tailored patient-centred approach to TBI management that links with the ethos of precision medicine. Methods & Materials: A research question was set using the PICO framework and key search terms were generated. A literature search was performed using the following databases: Ovid Medline, Ovid EMBASE and Web of Science. The review period was set between 2008 and 2018. Overall, 1811 articles were retrieved and systematically assessed using the PRISMA algorithm, SIGN study-design algorithm, CASP checklists and defined inclusion criteria. 10 articles were included in the critical analysis. Results: A considerable heterogeneity in the published evidence was noted. Critical analysis of the selected papers identified five factors which may influence functional outcomes: age, admission GCS, timing, imaging and pupil reactivity. Higher admission GCS and lower patient age have been linked with better functional outcomes; however the statistical significance of these findings is ambiguous. Discussion: While there is data available, much of it lacks appropriate and robust statistical analysis. Furthermore, studies often fail to reflect current best clinical practice and therefore do not provide tangible and realistic results. Accessing the existing raw data and putting it through rigorous statistical analysis, as a meta-analysis, would allow for more meaningful conclusions to be drawn.

• Item Type: Conference or Workshop Item
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Varsou, Dr Ourania
• Authors: Foytl, J., Varsou, O., and McKinley, M.
• College/School: College of Medical Veterinary and Life Sciences > School of Life Sciences

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