DECRA

DECRA Trial Summary

Objective

The DECRA (Decompressive Craniectomy in Diffuse Traumatic Brain Injury) trial aimed to evaluate whether decompressive craniectomy improves functional outcomes in patients with severe traumatic brain injury and refractory intracranial hypertension.

Methods

• Design: Multicenter, randomized controlled trial.
• Participants: 155 adults with severe diffuse traumatic brain injury and intracranial hypertension refractory to first-tier therapies.
• Interventions: Patients were randomized to undergo either bifrontotemporoparietal decompressive craniectomy or standard care.
• Outcome Measures: The primary outcome was the score on the Extended Glasgow Outcome Scale at 6 months.

Results

• Intracranial Pressure: Patients in the craniectomy group had significantly less time with intracranial pressures above the treatment threshold and required fewer interventions for increased intracranial pressure.
• Functional Outcome: Patients in the craniectomy group had worse scores on the Extended Glasgow Outcome Scale than those receiving standard care (odds ratio for a worse score, 1.84; P=0.03) and a greater risk of an unfavorable outcome (odds ratio, 2.21; P=0.02).
• Mortality: Rates of death at 6 months were similar between the craniectomy group (19%) and the standard care group (18%).

Conclusion

In adults with severe diffuse traumatic brain injury and refractory intracranial hypertension, early bifrontotemporoparietal decompressive craniectomy decreased intracranial pressure and ICU stay length but was associated with more unfavorable outcomes at 6 months.

Criticism

• Inclusion criteria to surgery group
• Crossover
• ↑ rate of unreactive pupils in surgical group

Reference

Cooper DJ, Rosenfeld JV, Murray L, et al. Decompressive Craniectomy in Diffuse Traumatic Brain Injury. N Engl J Med 2011; 364:1493-502. File:DECRA.pdf