Citation

Taylor J, Bailey M, Cooper DJ, Menon D, French C, Nichol A, Pisica D, Udy A, Volovici V, Higgins L. J. Neurotrauma 2024; ePub(ePub): ePub.

Copyright

(Copyright © 2024, Mary Ann Liebert Publishers)

DOI

10.1089/neu.2023.0493

PMID

38279804

Abstract

Traumatic brain injury (TBI) is a leading global cause of morbidity and mortality. Intracranial hypertension following moderate-to-severe TBI (m-sTBI) is a potentially modifiable secondary cerebral insult and one of the central therapeutic targets of contemporary neurocritical care. External ventricular drain (EVD) insertion is a common therapeutic intervention used to control intracranial hypertension and attenuate secondary brain injury. However, the optimal timing of EVD insertion in the setting of m-sTBI is uncertain and practice variation is widespread. Therefore, we aimed to assess if there is an association between timing of EVD placement and functional neurological outcome at 6-months post m-sTBI. We pooled individual patient data for all relevant harmonizable variables from the Erythropoietin in Traumatic Brain Injury (EPO-TBI) and Prophylactic Hypothermia Trial to Lessen Traumatic Brain Injury (POLAR) randomised control trials (RCT), and the Collaborative European NeuroTrauma Effectiveness Research in TBI (CENTER-TBI) Core Study version 3.0 and Australia-Europe NeuroTrauma Effectiveness Research in TBI (Oz-ENTER) prospective observational studies to create a combined dataset. The Glasgow Coma Scale (GCS) Score was used to define TBI severity and we included all patients admitted to an intensive care unit with a GCS ≤12, who were 15 years or older and underwent EVD placement within 7 days of injury. We used hierarchical multivariable logistic regression models to study the association between EVD insertion within 24-hours of injury (early) compared with EVD insertion more than 24-hours after injury (late) and 6-month functional neurological outcome measured using the Glasgow Outcome Score Extended (GOSE). An unfavorable functional neurological outcome was defined as a GOSE ≤4. In total 2,536 patients were assessed. Of these 502 (20%) underwent early EVD insertion and 145 (6%) underwent late EVD insertion. Following adjustment for the IMPACT score extended, sex, injury severity score, study and treatment site, patients receiving a late EVD had higher odds of an unfavorable functional neurological outcome at 6-months follow-up than those receiving an early EVD aOR; 95% CI, 2.14; 1.22-3.76; P = 0.008. Our study suggests that in patients with m-sTBI where an EVD is needed, early (≤24-hours post-injury) insertion may result in better long-term functional outcomes. This finding supports future prospective investigation in this area.

Language: en

Keywords

TRAUMATIC BRAIN INJURY; ADULT BRAIN INJURY; CLINICAL MANAGEMENT OF CNS INJURY; HEAD TRAUMA; INTRACRANIAL PRESSURE