Decompressive craniectomy (DC) is a critical intervention for managing severe traumatic brain injury (sTBI) in children when medical therapy fails, but the optimal timing remains unclear. This study evaluated the association between different DC timing and short-term outcomes in pediatric sTBI in Germany. A retrospective cohort study of the German national hospital discharge database was conducted for cases 2 h). Hierarchical logistic regression models evaluated the association of DC timing with in-hospital mortality, functional outcomes (Pediatric Complex Chronic Conditions (PCCC) ≥ 2)), poor outcome (composite outcome of death or PCCC ≥ 2), length of hospital stay, days on mechanical ventilation (MV) and coding of seizures. Among 13,492,821 children hospitalized, 9,495 had sTBI. DC was performed in 598 cases and half of surgeries were performed within the first two hours after admission. Higher odds of death (adjusted odds ratio OR 2.89; 95% confidence interval 95%CI 1.43–5.85) were observed in the early versus late DC groups. However, in survivors, early DC was linked to shorter durations MV and hospital stay. Sensitivity analyses across multiple thresholds of DC timing confirmed mortality and MV findings. Early DC in pediatric sTBI was primarily performed as an urgent intervention in critical injured patients, yet survivors showed faster recovery with few MV days and hospital stay.
Hojeij et al. (Sat,) studied this question.