Mersha WKedir Dekebi2025-03-202025-03-202024-10-23https://etd.aau.edu.et/handle/123456789/5185Background: Many local as well as global figures portends neurotrauma as a commonest cause of trauma mortality and brain trauma foundation designed a tier system to maximize care and reduce mortality. From those protocol, decompressive craniectomy (DC) is the last tier and likely potentially viable option in Low- and middle-income (LMIC) country like Ethiopia as there is lack of invasive neuromonitoring and control of intracranial pressure. We hope our study will make a room in our future patient selection and optimal care. Objectives: The main objective of this study was to assess the outcome and Determinants of outcome in 94 patients undergoing DC for trauma patients over 21 months and possibly propose Clinico-radiologic outcome predicting scores among patients undergoing DC during study period. Methodology: A multi-centric prospective cohort study was conducted from January 2023 to September 2024. 94 patients fulfilling inclusion criteria were included in the study and patients were followed till 90 days post operatively and death, favorable and unfavorable outcome using Extended Glasgow Outcome Score (EGOS) were studied at discharge, 30 days and 90 days. SPSS version 29 is used, margin of errors of 5% and CI=95% is utilized first in Chi-square, variables with p-value less than 0.05 is further analyzed using binomial logistic regression after outcome is dichotomized into favorable and unfavorable outcome, Univariate of each variable and multivariate logistic regression was done and Variables with p-value of <0.25 in the bivariable analysis entered to multivariable analysis. The statistical significance is declared at p-value <0.05. We used the measure of association Odd Ratio (OR) with 95% confidence interval. Result: Out of 94 there were 80 male and 14 female with mean age of, 41.5% of them were severe TB with GCS of <9 and at 3 months follow up after DC 29(30.9%) died and 55.3% had favorable outcome and 13.8% had unfavorable outcome. Univariate analysis of GCS at emergency less than 5(p<0.001), non-reactive pupil(p-0.007), Deranged vital sign at emergency(p-0.018), patient non responding to osmotic diuretic(p-0.001), presence of intra-operative hypotension(p-0.002) and requirement of intraoperative pressor support(p-0.008), immediate post -op GCS (p-0.007) where found to be statistically significant factor of poor outcome. Conclusion: DC is found as viable option for TBI in LMIC and low GCS (<5) at emergency and immediate post op, non-reactive pupil, deranged peri-operative hemodynamic status, use of peri-operative pressor support and patient not improving to osmotic diuretics were found to die and have poor outcome. Keywords: decompressive craniectomy, GCS, EGOS, Favorable and Unfavorable outcome.en-USdecompressive craniectomy GCS EGOS Favorable and Unfavorable outcome.Thesis