Does the requirement of a craniotomy predict outcome?: a preliminary investigation

The literature has been replete with reports that persons who require crani otomy for treatment of their traumatic brain injury have a far worse outcom e. The majority of these reports have utilized the rather global Glasgow Ou tcome Scale as a determinant of outcome. This paper sought to evaluate che effect of craniotomy on outcome as measured by the DRS. Data was collected on 341 persons (mean age 37.7 years) with traumatic brain injury treated at the Level I trauma centre, who required inpatient rehabilitation. Surgical interventions were classified as 'no surgery','one cranial surgery', or 't wo or more cranial surgeries'. Initial GCS scores revealed 44 persons at GC S 3-5, 102 persons at GCS 6-8, 83 persons at GCS 9-12 and 112 persons at GC S 13-15. The DRS was administered to each person at discharge from in-patie nt rehabilitation. Mean DRS scores were 7.07 for GCS 3-5, 6.03 for GCS 6-8, 6.53 for GCS 9-12, 5.57 for GCS 13-15 groups. A factorial ANOVA revealed a n interaction between initial GCS and surgical status. Univariate ANOVA's d emonstrated significant differences in the GCS 3-5 and GCS 13-15 groups, su ggesting a relationship between need for surgical intervention and less fav ourable outcome among persons who required in-patient rehabilitation. Howev er, no differences were demonstrated in the GCS 6-8 and GCS 9-12 soups. It appears chat requiring surgical intervention is prognostic at only the extr emes of the GCS categories and, thus, further investigation may reveal the limited role of need for surgical intervention injury in predicting outcome in persons with initial GCS 6-12.