The available data on DC to treat elevated ICP and brain shifts associated with STBI shows that the mortality has decreased 20-30% in the last two decades in the patients undergoing DC9,12,13.
The timing of DC is an important factor, especially for STBI with complex ASDH.
The raised ICP is one of the major deteriorating factors in patients with STBI though it may be in the form of thin layer ASDH, therefore prevention of intracranial hypertension by decompression plays a key role with respect to secondary brain injury12,16,20.
There are still many controversies regarding the use of DC in STBI, further studies are required so that we obtain additional valuable information for treatment protocol of patients with STBI.
Worldwide STBI is the leading cause of mortality/morbidity in trauma individuals, however to date there is no standard method to address this issue of preventing secondary brain injury due to post-traumatic raised intracranial pressure.
All participants returned to functional independence by 8 to 15 mo following acute STBI, including their ability to return to prior responsibilities such as work, school, homemaking, driving, and the ability to live independently; four are currently employed in professional roles (physician, accountant, lawyer, and bank manager) at 3 to 14 yr postinjury.
All participants met the criteria for STBI but resumed major life roles, including the return to work and school and the ability to function independently, within 8 to 15 mo of the trauma; several subsequently achieved professional degrees and/or assumed professional roles.
This STBI case series raises important questions about which preinjury and/or postinjury case characteristics or indicators would be sensitive enough to predict the potential for the return to independent living and gainful employment after STBI.
Veterans having STBI from military conflicts may have clinical characteristics that compare and differ from those of the civilians in this case series in several important ways.
Thus, it seems plausible that the recovery of continence and/or cognition during IR may still have potential as markers of future recovery of functional independence in veterans having psychological comorbidities in association with STBI as a result of combat-related trauma, including blast neurotrauma, which was not a mechanism of injury represented in this case series.
Further research is necessary to investigate whether bowel and bladder continence status is indeed a useful tool in STBI outcome prediction alone and/or in combination with other measures or factors such as those used in the IMPACT [7-8] and CRASH  databases.
Furthermore, this was a civilian case series involving STBI from nonpenetrating trauma; thus, limitations may exist in applying the findings to veterans with penetrating STBI.