Guidelines for the Management of Severe TBI: 2020 Update of the Decompressive Craniectomy Recommendations

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• The index of Guideline recommendations can be found below

• DECOMPRESSIVE CRANIECTOMY

  LEVEL I

  There was insufficient evidence to support a Level I recommendation for this topic.

  LEVEL II A - to improve mortality and overall outcomes

  1. NEW - Secondary DC performed for late refractory ICP elevation is recommended to improve mortality and favorable outcomes.

  2. NEW - Secondary DC performed for early refractory ICP elevation is not recommended to improve mortality and favorable outcomes.

  3. A large frontotemporoparietal DC (not less than 12 × 15 cm or 15 cm in diameter) is recommended over a small frontotemporoparietal DC for reduced mortality and improved neurological outcomes in patients with severe TBI.

  LEVEL II A - for ICP control

  4. NEW– Secondary DC, performed as a treatment for either early or late refractory ICP elevation, is suggested to reduce ICP and duration of intensive care, though the relationship between these effects and favorable outcome is uncertain.