Factors and Rates of Bone Flap Resorption in Pediatric Patients After Craniectomy for Traumatic Brain InjuryKeywords: children, traumatic brain injury, craniectomy, cranioplasty, outcomeInteractive ManuscriptAsk Questions of this Manuscript: What is the background behind your study?This question was not answered by the author What is the purpose of your study?This question was not answered by the author Describe your patient group.We found that 50.9% (27/53) of our sample patients experienced BFR. The average sample age was 6.25 years (+/- 4.73 yrs). Describe what you did.We performed a retrospective chart cohort review for long-term survivors that underwent DC for severe TBI from 1996 to 2010. We looked at the following variables: Age, sex, mechanism, GCS, Rotterdam score, comminuted skull fracture (SF), post-traumatic hydrocephalus (PTH), infection, time to AC and/or BFR. We analyzed these variables in a bivariate statistical fashion and we used a multivariate logistic regression model for the significant, and near-significant variables. Describe your main findings.The mean time to AC was 2.06 months (SD 2.27) and the mean time for BFR was 9.52 months (SD 7.64). Fifteen patients (28.3%) required permanent csf diversion with a ventriculoperitoneal shunt. Comminuted skull fractures were found in 30.2% of patients (16/53). 17% (9/53) had a wound infection. Univariate comparisons were made between a number of baseline variables and outcome of BFR. Significant associations were observed with comminuted skull fracture (p=.006), presence of infection (p=.02), hydrocephalus developing after AC (p= 0.01), & the presence of a permanent VPS (p=0.01). 81% (13/16) of patients with comminuted skull fractures, 80% (12/15) requiring permanent VPS, 88.9% (8/9) with post-operative infection, and & 90% (9/10) with hydrocephalus after AC had BFR. None of the other factors showed a significant association with BFR. We then used multivariate analysis to develop a predictive model (logistic regression, forward, conditional). The variables entered were comminuted skull fractures, permanent VPS, and age. Describe the main limitation of this study.This is a retrospective study. Describe your main conclusion.After DC for pediatric TBI, a very large percentage 50.9% of our AC patients experienced BFR. Describe the importance of your findings and how they can be used by others.Factors associated with BFR in a multivariate model were patients with permanent VPS, comminuted skull fractures, and age. We found that 50.9% (27/53) of our sample patients experienced BFR. The average sample age was 6.25 years (+/- 4.73 yrs). We performed a retrospective chart cohort review for long-term survivors that underwent DC for severe TBI from 1996 to 2010. We looked at the following variables: Age, sex, mechanism, GCS, Rotterdam score, comminuted skull fracture (SF), post-traumatic hydrocephalus (PTH), infection, time to AC and/or BFR. We analyzed these variables in a bivariate statistical fashion and we used a multivariate logistic regression model for the significant, and near-significant variables. The mean time to AC was 2.06 months (SD 2.27) and the mean time for BFR was 9.52 months (SD 7.64). Fifteen patients (28.3%) required permanent csf diversion with a ventriculoperitoneal shunt. Comminuted skull fractures were found in 30.2% of patients (16/53). 17% (9/53) had a wound infection. Univariate comparisons were made between a number of baseline variables and outcome of BFR. Significant associations were observed with comminuted skull fracture (p=.006), presence of infection (p=.02), hydrocephalus developing after AC (p= 0.01), & the presence of a permanent VPS (p=0.01). 81% (13/16) of patients with comminuted skull fractures, 80% (12/15) requiring permanent VPS, 88.9% (8/9) with post-operative infection, and & 90% (9/10) with hydrocephalus after AC had BFR. None of the other factors showed a significant association with BFR. We then used multivariate analysis to develop a predictive model (logistic regression, forward, conditional). The variables entered were comminuted skull fractures, permanent VPS, and age. This is a retrospective study. After DC for pediatric TBI, a very large percentage 50.9% of our AC patients experienced BFR. Factors associated with BFR in a multivariate model were patients with permanent VPS, comminuted skull fractures, and age. Project Roles:
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