Cochrane · systematic review · CD003983
Decompressive craniectomy for the treatment of high intracranial pressure in closed traumatic brain injury
Sahuquillo, J, Dennis, JA · Cochrane Database of Systematic Reviews · 2019 · Cochrane Library
InjuriesAMSTAR 2: not assessed
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
6
current version
GRADE rated
6
No studies
0
Included studies
NR
No studies 0 · 0%Ungraded 0 · 0%Very low 0 · 0%Low 2 · 33.3%Moderate 2 · 33.3%High 2 · 33.3%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Decompressive craniectomy compared to medical treatment only for the treatment of high intracranial pressure in closed traumatic brain injury
Population: patients > 12 months of age with a severe traumatic brain injury and in a coma (post‐resuscitation GOS score ≤ 8 points) with raised, refractory ICP
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Mortality at 6 months Decompressive craniectomy vs medical treatment only | RR 0.66 | 3 studies · 571 participants | Moderate Downgraded: indirectness |
Mortality at 12 months Decompressive craniectomy vs medical treatment only | RR 0.59 [0.45, 0.76] | 1 study · 373 participants | High |
'Unfavorable outcome' as per original Cochrane protocol at 6 months Decompressive craniectomy vs medical treatment only | RR 1 | 3 studies · 571 participants | Low Downgraded: imprecision, inconsistency, indirectness |
'Unfavorable outcome' as per original Cochrane protocol ‐ at 12 months Decompressive craniectomy vs medical treatment only | RR 0.95 [0.83, 1.09] | 1 study · 373 participants | High |
Changes in ICP from randomization up to 48 h Decompressive craniectomy vs medical treatment only | no estimate extracted | 2 studies · 182 participants | Moderate Downgraded: imprecision, inconsistency, indirectness |
Adverse events assessed in various ways, up to 24 months Decompressive craniectomy vs medical treatment only | no estimate extracted | 2 studies · 544 participants | Low Downgraded: imprecision, inconsistency, indirectness |