Intracranial pressure monitor in patients with traumatic brain injury

• Published in: The Journal of surgical research 2015-04, Vol.194 (2), p.565-570
• Main Authors: Tang, Andrew, MD, Pandit, Viraj, MD, Fennell, Vernard, MD, Jones, Trevor, MD, Joseph, Bellal, MD, O'Keeffe, Terence, MB ChB, Friese, Randall S., MD, Rhee, Peter, MD
• Format: Article
• Language: English
• Subjects: Adult; Arizona - epidemiology; Brain Injuries - mortality; Brain Injuries - physiopathology; Brain Injuries - therapy; Brain trauma foundation; Female; Guideline Adherence; Humans; Intracranial Pressure; Intracranial pressure monitoring; Male; Middle Aged; Monitoring, Physiologic; Mortality after traumatic brain injury; Practice Guidelines as Topic; Retrospective Studies; Surgery; Traumatic brain injury; Young Adult
• ISSN: 0022-4804; 1095-8673
• DOI: 10.1016/j.jss.2014.11.017

Abstract Background Brain Trauma Foundation (BTF) guidelines recommend intracranial pressure (ICP) monitoring for traumatic brain injury (TBI) patients with a Glasgow Coma Scale score of 8 or less with an abnormal head computed tomography, or a normal head computed tomography scan with systolic blood pressure ≤90 mm Hg, posturing, or in patients of age ≥40. The benefits of these guidelines on outcome remain unproven. We hypothesized that adherence to BTF guidelines for ICP monitoring does not improve outcomes in patients with TBI. Methods All TBI patients with an admission Glasgow Coma Scale ≤8 admitted to our level I trauma center over a 3-y period were identified. Adherence to the individual components of our institutional TBI Bundle (ICP monitoring, SpO2 ≥95%, PaCO2 30–39 mm Hg, systolic blood pressure ≥90 mm Hg, cerebral perfusion pressure ≥60 mm Hg, ICP ≤25 mm Hg, and temperature 36°C–37°C) was assessed. Patients were stratified into two groups as follows: patients with ICP monitoring (ICP) and patients without ICP monitoring (no-ICP). Outcome measures were survival and discharge disposition. Multivariate regression analysis was performed. Results We identified 2618 TBI patients, 261 of whom met the BTF criteria for ICP monitoring. After excluding those with nonsurvivable injuries ( n  = 67), 194 patients were available for analysis. The two groups were similar in demographics and severity of head injury. Survival rate was higher in the no-ICP group compared with that in the ICP group (98% versus 76%, P