Background: The timing of decompressive craniectomy (DC) in managing traumatic brain injury (TBI) remains a contentious issue, with debates surrounding the outcomes and predictors of early versus late intervention. Methods: This observational, prospective cohort study included patients undergoing DC for TBI at a tertiary care center. Patients were divided into early (within 24 hours post-injury) and late (after 24 hours post-injury) DC groups. Data on demographics, mode of injury, pre- and post-operative Glasgow Coma Scale (GCS) scores, presence of mass effect, midline shift, time to surgery, and Glasgow Outcome Scale Extended (GOSE) scores at discharge were collected and analyzed. Results: A total of 174 patients were studied, with 87 in each group. No significant difference was observed in age distribution (p=0.41) or gender (p=1.0). Mode of injury significantly influenced the timing of DC, with falls more common in late DC (51.72% vs. 17.24%, p<.0001). The late DC group had higher pre-operative GCS scores (9.32 ± 3.91 vs. 5.83 ± 2.45, p<.0001). Mass effect was present in all early DC patients but in only 19.54% of late DC patients (p<.0001). The mean time to surgery was significantly shorter in the early DC group (9.2 ± 2.88 hours vs. 64.17 ± 29.62 hours, p<.0001). The late DC group showed a higher percentage of favorable GOSE scores at discharge (47.13% vs. 10.34%, p<.0001). Conclusion: The study suggests that while early DC is crucial for patients with significant mass effect and midline shift, late DC can result in comparable or better outcomes for patients with higher initial GCS scores or different modes of injury. The decision on the timing of DC should be individualized based on clinical presentation and injury characteristics.

Background: The timing of decompressive craniectomy (DC) in managing traumatic brain injury (TBI) remains a contentious issue, with debates surrounding the outcomes and predictors of early versus late intervention. Methods: This observational, prospective cohort study included patients undergoing DC for TBI at a tertiary care center. Patients were divided into early (within 24 hours post-injury) and late (after 24 hours post-injury) DC groups. Data on demographics, mode of injury, pre- and post-operative Glasgow Coma Scale (GCS) scores, presence of mass effect, midline shift, time to surgery, and Glasgow Outcome Scale Extended (GOSE) scores at discharge were collected and analyzed. Results: A total of 174 patients were studied, with 87 in each group. No significant difference was observed in age distribution (p=0.41) or gender (p=1.0). Mode of injury significantly influenced the timing of DC, with falls more common in late DC (51.72% vs. 17.24%, p<.0001). The late DC group had higher pre-operative GCS scores (9.32 ± 3.91 vs. 5.83 ± 2.45, p<.0001). Mass effect was present in all early DC patients but in only 19.54% of late DC patients (p<.0001). The mean time to surgery was significantly shorter in the early DC group (9.2 ± 2.88 hours vs. 64.17 ± 29.62 hours, p<.0001). The late DC group showed a higher percentage of favorable GOSE scores at discharge (47.13% vs. 10.34%, p<.0001). Conclusion: The study suggests that while early DC is crucial for patients with significant mass effect and midline shift, late DC can result in comparable or better outcomes for patients with higher initial GCS scores or different modes of injury. The decision on the timing of DC should be individualized based on clinical presentation and injury characteristics.