Increased mortality in patients with severe traumatic brain injury treated without intracranial pressure monitoring. Academic Article uri icon

Overview

abstract

  • OBJECT: Evidence-based guidelines recommend intracranial pressure (ICP) monitoring for patients with severe traumatic brain injury (TBI), but there is limited evidence that monitoring and treating intracranial hypertension reduces mortality. This study uses a large, prospectively collected database to examine the effect on 2-week mortality of ICP reduction therapies administered to patients with severe TBI treated either with or without an ICP monitor. METHODS: From a population of 2134 patients with severe TBI (Glasgow Coma Scale [GCS] Score <9), 1446 patients were treated with ICP-lowering therapies. Of those, 1202 had an ICP monitor inserted and 244 were treated without monitoring. Patients were admitted to one of 20 Level I and two Level II trauma centers, part of a New York State quality improvement program administered by the Brain Trauma Foundation between 2000 and 2009. This database also contains information on known independent early prognostic indicators of mortality, including age, admission GCS score, pupillary status, CT scanning findings, and hypotension. RESULTS: Age, initial GCS score, hypotension, and CT scan findings were associated with 2-week mortality. In addition, patients of all ages treated with an ICP monitor in place had lower mortality at 2 weeks (p = 0.02) than those treated without an ICP monitor, after adjusting for parameters that independently affect mortality. CONCLUSIONS: In patients with severe TBI treated for intracranial hypertension, the use of an ICP monitor is associated with significantly lower mortality when compared with patients treated without an ICP monitor. Based on these findings, the authors conclude that ICP-directed therapy in patients with severe TBI should be guided by ICP monitoring.

publication date

  • August 17, 2012

Research

keywords

  • Brain Injuries
  • Intracranial Hypertension
  • Intracranial Pressure
  • Monitoring, Physiologic
  • Severity of Illness Index

Identity

Scopus Document Identifier

  • 84868364472

Digital Object Identifier (DOI)

  • 10.3171/2012.7.JNS111816

PubMed ID

  • 22900846

Additional Document Info

volume

  • 117

issue

  • 4