Decompressive Craniectomy for Traumatic Brain Injury: Outcomes and Predictive Factors at Ethiopian Tertiary Centers

Abstract Background Decompressive craniectomy (DC) is commonly performed to control refractory intracranial hypertension after traumatic brain injury (TBI). This study aimed to identify the clinical, radiological, and perioperative factors associated with functional outcomes following DC among patients with TBI treated at tertiary hospitals in Addis Ababa, Ethiopia. Methods A prospective multicenter cohort study was conducted among consecutive patients with TBI who underwent decompressive craniectomy at four teaching hospitals affiliated with the Addis Ababa University. Sociodemographic, clinical, radiological, intraoperative, and postoperative data were collected. Functional outcomes were assessed using the Extended Glasgow Outcome Scale (EGOS) at discharge, 3, and 6 months. Univariate and multivariate logistic regression analyses were performed to determine the factors associated with poor outcomes. Results A total of 94 patients were included (mean age 38.9 ± 15 years), with a predominance of male patients (88.3%). Road traffic accidents were the leading cause of injury (54.3%). At 6 months, mortality was 33%, whereas 59.6% of patients achieved a favorable functional outcome (EGOS 5–8). On multivariable analysis, admission Glasgow Coma Scale (GCS) independently predicted poor outcomes. Compared with patients with GCS 13–15, those with GCS < 5 (adjusted OR 8.07; 95% CI 2.25–23.7) and GCS 5–8 (adjusted OR 27.06; 95% CI 3.92–29.83) had significantly higher odds of poor outcomes (likelihood ratio test, p = 0.001). In addition, surgery performed 24–72 h after injury was independently associated with poor outcomes compared with surgery within 24 h (adjusted OR 5.98; 95% CI 1.47–30.38; p = 0.02). Conclusion Decompressive craniectomy provides acceptable survival and functional outcomes in patients with traumatic brain injury in resource-limited settings. Admission GCS and timing of surgical intervention were the most important independent predictors of outcome.