{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T23:52:24Z","timestamp":1788047544860,"version":"build-2784847793"},"reference-count":34,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,5,25]],"date-time":"2021-05-25T00:00:00Z","timestamp":1621900800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100013064","name":"Key Research and Development Program of Jiangxi Province","doi-asserted-by":"publisher","award":["20203BBGL73174"],"award-info":[{"award-number":["20203BBGL73174"]}],"id":[{"id":"10.13039\/501100013064","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:p><jats:bold>Objective:<\/jats:bold> Decompressive craniectomy (DC) plays an important role in the treatment of patients with severe traumatic brain injury (sTBI) with mass lesions and intractably elevated intracranial hypertension (ICP). However, whether DC should be performed in patients with bilateral dilated pupils and a low Glasgow Coma Scale (GCS) score is still controversial. This retrospective study explored the clinical outcomes and risk factors for an unfavorable prognosis in sTBI patients undergoing emergency DC with bilateral dilated pupils and a GCS score &amp;lt;5.<\/jats:p><jats:p><jats:bold>Methods:<\/jats:bold> The authors reviewed the data from patients who underwent emergency DC from January 2012 to March 2019 in a medical center in China. All data, such as patient demographics, radiological findings, clinical parameters, and preoperative laboratory variables, were extracted. Multivariate logistic regression analysis was performed to determine the factors associated with 30-day mortality and 6-month negative neurological outcome {defined as death or vegetative state [Glasgow Outcome Scale (GOS) score 1\u20132]}.<\/jats:p><jats:p><jats:bold>Results:<\/jats:bold> A total of 94 sTBI patients with bilateral dilated pupils and a GCS score lower than five who underwent emergency DC were enrolled. In total, 74 patients (78.7%) died within 30 days, and 84 (89.4%) had a poor 6-month outcome (GOS 1\u20132). In multivariate analysis, advanced age (OR: 7.741, CI: 2.288\u201326.189), prolonged preoperative activated partial thromboplastin time (aPTT) (OR: 7.263, CI: 1.323\u201339.890), and low GCS (OR: 6.162, CI: 1.478\u201325.684) were associated with a higher risk of 30-day mortality, while advanced age (OR: 8.812, CI: 1.817\u201342.729) was the only independent predictor of a poor 6-month prognosis in patients undergoing DC with preoperative bilateral dilated pupils and a GCS score &amp;lt;5.<\/jats:p><jats:p><jats:bold>Conclusions:<\/jats:bold> The mortality and disability rates are extremely high in severe TBI patients undergoing emergency DC with bilateral fixed pupils and a GCS score &amp;lt;5. DC is more valuable for younger patients.<\/jats:p>","DOI":"10.3389\/fneur.2021.656369","type":"journal-article","created":{"date-parts":[[2021,5,25]],"date-time":"2021-05-25T06:01:11Z","timestamp":1621922471000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":14,"title":["Outcomes of Traumatic Brain-Injured Patients With Glasgow Coma Scale &lt; 5 and Bilateral Dilated Pupils Undergoing Decompressive Craniectomy"],"prefix":"10.3389","volume":"12","author":[{"given":"Zhiji","family":"Tang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruijin","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jinshi","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qianliang","family":"Huang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoping","family":"Zhou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenjin","family":"Wei","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiuhua","family":"Jiang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2021,5,25]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"S193","DOI":"10.1038\/nature16035","article-title":"Global neurotrauma research challenges and opportunities","volume":"527","author":"Rubiano Escobar","year":"2015","journal-title":"Nature."},{"key":"B2","doi-asserted-by":"publisher","first-page":"535","DOI":"10.23736\/S0390-5616.18.04532-0","article-title":"Epidemiology of severe traumatic brain injury","volume":"62","author":"Iaccarino","year":"2018","journal-title":"J Neurosurg Sci."},{"key":"B3","doi-asserted-by":"publisher","first-page":"e1002332","DOI":"10.1371\/journal.pmed.1002332","article-title":"Trends in traumatic brain injury mortality in China, 2006\u20132013: a population-based longitudinal study","volume":"14","author":"Cheng","year":"2017","journal-title":"PLoS Med."},{"key":"B4","doi-asserted-by":"publisher","first-page":"286","DOI":"10.1016\/S1474-4422(18)30469-1","article-title":"Traumatic brain injury in China","volume":"18","author":"Jiang","year":"2019","journal-title":"Lancet Neurol."},{"key":"B5","doi-asserted-by":"publisher","first-page":"238","DOI":"10.1053\/apmr.2003.50097","article-title":"Financial and vocational outcomes 1 year after traumatic brain injury","volume":"84","author":"Johnstone","year":"2003","journal-title":"Arch Phys Med Rehabil."},{"key":"B6","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1177\/1066480717752905","article-title":"The secondary impact of traumatic brain injury: an interpretative phenomenological analysis of the experiences of family and friends","volume":"26","author":"Townshend","year":"2017","journal-title":"Fam J."},{"key":"B7","doi-asserted-by":"publisher","first-page":"330","DOI":"10.1007\/s11940-014-0330-5","article-title":"Decompressive craniectomy in neurocritical care","volume":"17","author":"Chu","year":"2015","journal-title":"Curr Treat Options Neurol."},{"key":"B8","doi-asserted-by":"publisher","first-page":"1119","DOI":"10.1056\/NEJMoa1605215","article-title":"Trial of decompressive craniectomy for traumatic intracranial hypertension","volume":"375","author":"Hutchinson","year":"2016","journal-title":"N Engl J Med."},{"key":"B9","doi-asserted-by":"publisher","first-page":"6","DOI":"10.1227\/NEU.0000000000001432","article-title":"Guidelines for the management of severe traumatic brain injury, fourth edition","volume":"80","author":"Carney","year":"2017","journal-title":"Neurosurgery"},{"key":"B10","doi-asserted-by":"publisher","first-page":"1570","DOI":"10.1097\/TA.0b013e3181a594c4","article-title":"Impact of decompressive craniectomy on functional outcome after severe traumatic brain injury","volume":"66","author":"Williams","year":"2009","journal-title":"J Trauma."},{"key":"B11","doi-asserted-by":"publisher","first-page":"1605","DOI":"10.1186\/s40064-016-3251-9","article-title":"Decompressive craniectomy for severe traumatic brain injury: clinical study, literature review and meta-analysis","volume":"5","author":"Grindlinger","year":"2016","journal-title":"SpringerPlus."},{"key":"B12","doi-asserted-by":"publisher","first-page":"1886","DOI":"10.1016\/j.injury.2016.04.017","article-title":"Predicting long-term neurological outcomes after severe traumatic brain injury requiring decompressive craniectomy: a comparison of the CRASH and IMPACT prognostic models","volume":"2016","author":"Honeybul","year":"2016","journal-title":"Injury."},{"key":"B13","doi-asserted-by":"publisher","first-page":"1311","DOI":"10.1089\/neu.2005.22.1311","article-title":"Role of decompressive surgery in the management of severe head injuries: prognostic factors and patient selection","volume":"22","author":"Ucar","year":"2005","journal-title":"J Neurotrauma."},{"key":"B14","doi-asserted-by":"publisher","first-page":"207585","DOI":"10.1155\/2014\/207585","article-title":"Study of the long-term results of decompressive craniectomy after severe traumatic brain injury based on a series of 60 consecutive cases","volume":"2014","author":"Ga\u00e9tane","year":"2014","journal-title":"Sci World J."},{"key":"B15","doi-asserted-by":"publisher","first-page":"19","DOI":"10.4103\/2152-7806.176671","article-title":"According to which factors in severe traumatic brain injury craniectomy could be beneficial","volume":"7","author":"Fotakopoulos","year":"2016","journal-title":"Surg Neurol Int."},{"key":"B16","first-page":"190","article-title":"Outcome determinants of decompressive craniectomy in patients with traumatic brain injury; a single center experience from Southern Iran","volume":"5","author":"Khalili","year":"2017","journal-title":"Bull Emerg Trauma."},{"key":"B17","doi-asserted-by":"publisher","first-page":"730","DOI":"10.4103\/ajns.AJNS_6_18","article-title":"Factors affecting functional outcome after decompressive craniectomy performed for traumatic brain injury: a retrospective, cross-sectional study","volume":"13","author":"Khan","year":"2018","journal-title":"Asian J Neurosurg."},{"key":"B18","doi-asserted-by":"publisher","first-page":"465","DOI":"10.1007\/s00068-010-0002-4","article-title":"Emergency decompressive craniectomy for trauma patients with Glasgow Coma Scale of 3 and bilateral fixed dilated pupils","volume":"36","author":"Jamous","year":"2010","journal-title":"Eur J Trauma Emerg Surg."},{"key":"B19","doi-asserted-by":"publisher","first-page":"1563","DOI":"10.1007\/s00381-010-1103-4","article-title":"Severe traumatic brain injury in children\u2014a single center experience regarding therapy and long-term outcome","volume":"26","author":"Thomale","year":"2010","journal-title":"Childs Nerv Syst."},{"key":"B20","doi-asserted-by":"publisher","first-page":"1627","DOI":"10.2147\/TCRM.S89820","article-title":"Decompressive craniectomy for severe traumatic brain injury patients with fixed dilated pupils","volume":"11","author":"Mao","year":"2015","journal-title":"Ther Clin Risk Manag."},{"key":"B21","doi-asserted-by":"publisher","first-page":"97","DOI":"10.1097\/MCC.0000000000000481","article-title":"Long-term outcome following decompressive craniectomy: an inconvenient truth?","volume":"24","author":"Honeybul","year":"2018","journal-title":"Curr Opin Crit Care."},{"key":"B22","doi-asserted-by":"publisher","first-page":"187","DOI":"10.1097\/00005373-197403000-00001","article-title":"The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care","volume":"14","author":"Baker","year":"1974","journal-title":"J Trauma."},{"key":"B23","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s12028-018-0526-8","article-title":"Midline shift is unrelated to subjective pupillary reactivity assessment on admission in moderate and severe traumatic brain injury","volume":"29","author":"Nourallah","year":"2018","journal-title":"Neurocrit Care."},{"key":"B24","doi-asserted-by":"publisher","first-page":"877","DOI":"10.1227\/01.NEU.0000137658.14906.E4","article-title":"Hyperglycemia and brain tissue pH after traumatic brain injury","volume":"55","author":"Zygun","year":"2004","journal-title":"Neurosurgery."},{"key":"B25","doi-asserted-by":"publisher","first-page":"508","DOI":"10.1097\/TA.0b013e3181b2519f","article-title":"Early progression of traumatic cerebral contusions: characterization and risk factors","volume":"67","author":"White","year":"2009","journal-title":"J Trauma."},{"key":"B26","doi-asserted-by":"publisher","first-page":"2137","DOI":"10.1089\/neu.2011.2233","article-title":"Predicting progressive hemorrhagic injury after traumatic brain injury: derivation and validation of a risk score based on admission characteristics","volume":"29","author":"Yuan","year":"2012","journal-title":"J Neurotrauma."},{"key":"B27","doi-asserted-by":"publisher","first-page":"1521","DOI":"10.1089\/neu.2013.3241","article-title":"Early hemorrhagic progression of traumatic brain contusions: frequency, correlation with coagulation disorders, and patient outcome: a prospective study","volume":"31","author":"Juratli","year":"2014","journal-title":"J Neurotrauma."},{"key":"B28","doi-asserted-by":"publisher","first-page":"190","DOI":"10.4103\/1793-5482.161171","article-title":"Hypocalcemia as a prognostic factor in mortality and morbidity in moderate and severe traumatic brain injury","volume":"10","author":"Manuel","year":"2015","journal-title":"Asian J Neurosurg."},{"key":"B29","doi-asserted-by":"publisher","first-page":"1279","DOI":"10.1089\/neu.2015.4205","article-title":"Coagulopathy in traumatic brain injury and its correlation with progressive hemorrhagic injury: a systematic review and meta-analysis","volume":"33","author":"Yuan","year":"2016","journal-title":"J Neurotrauma."},{"key":"B30","doi-asserted-by":"publisher","first-page":"112","DOI":"10.13004\/kjnt.2014.10.2.112","article-title":"Outcomes of ultra-early decompressive craniectomy after severe traumatic brain injury-treatment outcomes after severe TBI","volume":"10","author":"Park","year":"2014","journal-title":"Kor J Neurotrauma."},{"key":"B31","doi-asserted-by":"publisher","first-page":"59","DOI":"10.1016\/j.wneu.2015.12.041","article-title":"Prognostic impact of intracranial pressure monitoring after primary decompressive craniectomy for traumatic brain injury","volume":"88","author":"Huang","year":"2015","journal-title":"World Neurosurg."},{"key":"B32","doi-asserted-by":"publisher","first-page":"654","DOI":"10.1136\/emermed-2014-204260","article-title":"Prognosis of patients with bilateral fixed dilated pupils secondary to traumatic extradural or subdural haematoma who undergo surgery: a systematic review and meta-analysis","volume":"32","author":"Scotter","year":"2014","journal-title":"Emerg Med J."},{"key":"B33","doi-asserted-by":"publisher","first-page":"1329","DOI":"10.3171\/2013.1.JNS121775","article-title":"Thirty-day mortality in traumatically brain-injured patients undergoing decompressive craniectomy","volume":"118","author":"Huang","year":"2013","journal-title":"J Neurosurg."},{"key":"B34","doi-asserted-by":"publisher","first-page":"109","DOI":"10.1007\/978-3-211-85578-2_22","article-title":"Predictive values of age and the Glasgow Coma Scale in traumatic brain injury patients treated with decompressive craniectomy","volume":"102","author":"Potts","year":"2008","journal-title":"Acta Neurochir Suppl."}],"container-title":["Frontiers in Neurology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2021.656369\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,5,25]],"date-time":"2021-05-25T06:01:16Z","timestamp":1621922476000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2021.656369\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,5,25]]},"references-count":34,"alternative-id":["10.3389\/fneur.2021.656369"],"URL":"https:\/\/doi.org\/10.3389\/fneur.2021.656369","relation":{},"ISSN":["1664-2295"],"issn-type":[{"value":"1664-2295","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,5,25]]},"article-number":"656369"}}