Surgical Versus Medical Management for Severe Pediatric Traumatic Brain Injury: A Systematic Review and Meta-Analysis.

In 30 seconds

This systematic review and meta-analysis compared decompressive craniectomy (DC) with medical management (MM) for severe traumatic brain injury in patients younger than 18 years. It included 553 DC and 2336 MM patients across one randomized trial and 10 observational studies. Pooled results showed no significant difference in good functional outcomes or mortality (relative risk 1.06, 95% CI 0.69-1.64; P = .78). DC was associated with a longer intensive care unit stay, with a mean difference of 6.2 days (95% CI 4.4-8.0; P < .001).

Key findings

• Pooled analysis found no significant difference in good functional outcomes or mortality between DC and MM (1.06, 95% CI 0.69-1.64; P = .78).
• DC was associated with a longer intensive care unit stay (mean difference, 6.2 days, 95% CI 4.4-8.0; P < .001).
• Hospital stay showed a nonsignificant trend toward being longer with DC (mean difference, 4.0 days, 95% CI -0.6 to 8.7; P = .09); this became significant on sensitivity analysis.
• Reported complication rates were low and comparable between groups.

Why it matters

The findings do not establish a survival or functional advantage for DC over medical management in children with severe TBI, while indicating greater intensive care use. This comparison is relevant to weighing potential benefits against resource and recovery burdens, but the evidence remains uncertain and does not resolve which patients may benefit from surgery.

What to keep in mind

The evidence was mainly from small, heterogeneous retrospective studies, with only one randomized trial; the authors call for larger prospective multicenter studies.