The Impact of Decompressive Craniectomy on the Prognosis of Pediatric Patients with Moderate-to-Severe Traumatic Brain Injury: A Retrospective Matched Case-Control Study

Abstract Background Traumatic brain injury (TBI) is a significant cause of disability and mortality in children. Decompressive craniectomy (DC) is a treatment strategy to manage refractory intracranial hypertension in patients with TBI. However, the efficacy of DC in children with moderate-to-severe TBI remains unclear. Objective This paired case–control study analyzes the characteristics of moderate-to-severe TBI in children treated with DC and explores the clinical effect of DC compared with non-DC treatment. Methods Retrospective matched case–control analysis was conducted on 47 children with moderate-to-severe TBI who underwent DC. Each child who underwent DC was matched with one child who did not undergo DC according to age, Glasgow coma scale (GCS), pupil response, and cranial CT findings on admission to make the primary condition of injury as comparable as possible. Mortality, Pediatric Cerebral Performance Category (PCPC) at discharge, duration of mechanical ventilation, length of stay in ICU, and length of stay in the hospital were compared between the two groups. Results The DC and non-DC groups did not show a statistically significant difference in mortality ( p = 0.199). However, the DC group exhibited a superior PCPC score upon discharge ( p = 0.014) compared to the non-DC group. No statistically significant differences were found in the Glasgow Outcome Scale (GOS) at 3 months ( p = 0.189), duration of mechanical ventilation ( p = 0.819), length of ICU stay ( p = 0.206), or length of hospital stay ( p = 0.935) between the two groups. Conclusion Pediatric patients who receive DC demonstrate an improved Pediatric PCPC score at discharge compared to those treated without DC. However, there is no statistically significant difference in mortality between the two groups.