TY - JOUR
T1 - Long-Term outcome following decompressive craniectomy
T2 - An inconvenient truth?
AU - Honeybul, S.
AU - Ho, K.M.
AU - Gillett, G.R.
PY - 2018/4/1
Y1 - 2018/4/1
N2 - Purpose of review There is little doubt that decompressive craniectomy can reduce mortality following malignant middle cerebral infarction or severe traumatic brain injury. However, the concern has always been that the reduction in mortality comes at the cost of an increase in the number of survivors with severe neurological disability. Recent findings There has been a number of large multicentre randomized trials investigating surgical efficacy of the procedure. These trials have clearly demonstrated a survival benefit in those patients randomized to surgical decompression. However, it is only possible to demonstrate an improvement in outcome if the definition of favourable is changed such that it includes patients with either a modified Rankin score of 4 or upper severe disability. Without this recategorization, the results of these trials have confirmed the 'Inconvenient truth' that surgery reduces mortality at the expense of survival with severe disability. Summary Given these results, the time may have come for a nuanced examination of the value society places on an individual life, and the acceptability or otherwise of performing a procedure that converts death into survival with severe disability.
AB - Purpose of review There is little doubt that decompressive craniectomy can reduce mortality following malignant middle cerebral infarction or severe traumatic brain injury. However, the concern has always been that the reduction in mortality comes at the cost of an increase in the number of survivors with severe neurological disability. Recent findings There has been a number of large multicentre randomized trials investigating surgical efficacy of the procedure. These trials have clearly demonstrated a survival benefit in those patients randomized to surgical decompression. However, it is only possible to demonstrate an improvement in outcome if the definition of favourable is changed such that it includes patients with either a modified Rankin score of 4 or upper severe disability. Without this recategorization, the results of these trials have confirmed the 'Inconvenient truth' that surgery reduces mortality at the expense of survival with severe disability. Summary Given these results, the time may have come for a nuanced examination of the value society places on an individual life, and the acceptability or otherwise of performing a procedure that converts death into survival with severe disability.
KW - decompressive craniectomy
KW - ethics
KW - malignant middle cerebral artery stroke
KW - neurotrauma
KW - randomized controlled trials
KW - traumatic brain injury
UR - http://www.scopus.com/inward/record.url?scp=85044203867&partnerID=8YFLogxK
U2 - 10.1097/MCC.0000000000000481
DO - 10.1097/MCC.0000000000000481
M3 - Review article
C2 - 29369063
AN - SCOPUS:85044203867
SN - 1070-5295
VL - 24
SP - 97
EP - 104
JO - Current Opinion in Critical Care
JF - Current Opinion in Critical Care
IS - 2
ER -