Clinical study of quality of life of traumatic brain injury patients after decompressive craniectomy and related influencing factors

Abstract

Background: Decompressive craniectomy (DC) in traumatic brain injury (TBI) patients has been subject of debate for neurosurgeons since long time. Our goal in this study is to evaluate the quality of life of these patients and to look at the problem from their point of view. Methods: Quality of Life after Traumatic Brain injury (QOLIBRI) instrument is was applied to 105 TBI patients who performed DC. Age, gender, the mode of injury and level of education, time from TBI to DC, lowest GCS score post-injury, presence of a corneal reflex, whether patients performed reconstructive cranioplasty or not, blood pressure, patient temperature, midline shift on CT scan, fasting blood glucose, whether patients performed rehabilitation therapy, days of use of mannitol and barbiturates sedation were recorded. Results: Sex of the patient, educational background, time between TBI to perform DC surgery, pupillary response of patient before surgery, systolic and diastolic blood pressures, fasting blood glucose, rehabilitation and use of barbiturates did not prove to have any statistical significant impact on the patient's QOLIBRI score. Young patients were found to be scoring more in the social domain (P = 0.02). Higher Glasgow Coma Score (GCS) patients scored statistically better in the cognitive (p = 0.00), self (0.00), daily life (p = 0.00), social (p = 0.00), emotion (p = 0.00) and total QOLIBRI (p = 0.00) score. Interestingly, the longer the time interval between TBI and time at QOLIBRI instrument application, the lower the score for cognitive (p = 0.00), self (p = 0.04), daily life (p = 0.02), emotion (p = 0.05) and total QOLIBRI (p = 0.02) score. Reconstructive cranioplasty proved to positively affect the emotion (p = 0.05), social life (p = 0.01) and total QOLIBRI (p = 0.05) score. Temperature had a negative influence on the cognitive (p = 0.01), self (p = 0.01) and daily life score (p = 0.01). Midline shift on CT imaging had a negative influence on cognitive (p = 0.00), self (p = 0.00), daily life (p = 0.00), social (p = 0.00), emotion (p = 0.05) and total QOLIBRI (p = 0.00) score. Conclusion: QOLIBRI proves to be an excellent tool for evaluation of TBI patients who undergone DC. Regular assessment comparisons can help to tailor personalized rehabilitation treatment strategies for patients.