Early Outcome Following Decompressive Craniectomy for Traumatic Brain Injury: A Prediction Model LETTER: W e read with keen interest the article by Tian et al 1 regarding the predictive model of early outcome and discharge after decompressive craniectomy (DC) for severe traumatic brain injury published in your esteemed journal. We appreciate the authors for undertaking this study; however, we have some concerns regarding this article that merit discussion. The authors mentioned that the indications for DC included a thickness of greater than 1 cm in cases of extracerebral hematoma and a volume greater than 30 mL in cases of intracerebral hema- toma, which needs further elaboration as in our experience patients of subdural hemorrhage with thickness greater than 1 cm do not need DC if the brain is lax after evacuation of subdural hemorrhage. Similarly, most intracerebral hemorrhages greater than 30 mL can be managed by craniotomy and evacuation and DC is not needed in most cases. Hence, it would have been more fruitful if the authors highlighted what were the indications of performing DC in such cases instead of craniotomy and evacua- tion of hematoma. Another issue that merits discussion is that the authors did not provide the preoperative intracranial pressure cutoff values for which they have considered the patients for DC. The authors have mentioned that the tracheostomized patients had worse outcome compared with non-tracheostomized patients, but it would have been more useful if the authors highlighted the timing of tracheostomy as early tracheostomy has been reported to have a good outcome. 2 Severe traumatic brain injury is generally associated with concomitant injuries. The authors have mentioned the co-injuries such as bone fractures and lung contusions, but this does not yield any fruitful information. The authors should have mentioned Injury Severity Score, which would have highlighted the severity of trauma and affected the early outcome and timing of discharge after DC. 3 Revanth Goda 1 , Ravi Sharma 1 , Varidh Katiyar 1 , Raghav Singla 3 , Sachin Borkar 1 , Zainab Vora 2 From the Departments of 1 Neurosurgery and 2 Radiology, All India Institute of Medical Sciences, New Delhi; and 3 Department of Neurosurgery, PGIMER Chandigarh, Chandigarh, India To whom correspondence should be addressed: Raghav Singla, M.Ch. [E-mail: Singlaneuro@gmail.com] https://doi.org/10.1016/j.wneu.2019.02.253. REFERENCES 1. Tian R, Liu W, Dong J, et al. Prognostic predictors of early outcome and discharge status of patients undergoing decompressive craniectomy after severe traumatic brain injury. World Neurosurg. 2019;126:e101-e108. 2. Lu Q, Xie Y, Qi X, Li X, Yang S, Wang Y. Is early tracheostomy better for severe traumatic brain injury? A meta-analysis. World Neurosurg. 2018;112:e324-e330. 3. Foreman BP, Caesar RR, Parks J, et al. Usefulness of the abbreviated injury score and the injury severity score in comparison to the Glasgow Coma Scale in pre- dicting outcome after traumatic brain injury. J Trauma Acute Care Surg. 2007;62: 946-950. 656 www.SCIENCEDIRECT.com 127: 656, JULY 2019 WORLD NEUROSURGERY Letter to the Editor