Citation

Al Saiegh F, Philipp L, Mouchtouris N, Chalouhi N, Khanna O, Shah SO, Jallo J. World Neurosurg. 2020; ePub(ePub): ePub.

Affiliation

Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA. Electronic address: jack.jallo@jefferson.edu.

Copyright

(Copyright © 2020, Elsevier Publishing)

DOI

10.1016/j.wneu.2020.01.070

PMID

31954892

Abstract

BACKGROUND: Severe traumatic brain injury (TBI) remains a major cause of morbidity and mortality with mortality rates reaching 35%. Intracranial pressure (ICP) monitoring is used to prevent secondary brain injury and death. However, while the association of elevated ICP and worsened outcomes is accepted, routine ICP monitoring has been questioned after the publication of several studies including the BEST:TRIP trial. We examined whether severe TBI patients in the trauma system of Pennsylvania fared better with or without ICP monitoring.

METHODS: We conducted a statewide retrospective analysis and included all TBI patients >18 years with an admission Glasgow Coma Scale (GCS) <9 from January 2000 through December 2017. The primary outcome was mortality. Secondary outcomes examined were ICU length of stay (LOS) and discharge functional independence measure (FIM).

RESULTS: A total of 36,929 patients matched our inclusion criteria and were included in the analysis. Of those, 6,025 (16.3%) had ICP monitor placement. Mean ICU LOS was significantly higher in ICP-monitored patients (13.1±11.6 days versus 6.0±10.8 days,P<0.0001). Increasing age was a significant predictor of death (P<0.0001). Mean FIM scores at discharge were significantly higher in patients without an ICP monitor (16.21 ± 4.91 vs. 9.53 ± 5.07,P<0.0001). When controlling for injury severity score, GCS, age, and craniotomy, ICP monitoring conferred a hazard ratio of 0.85 (χ2=32.63, P<0.0001) - a 25% reduction of in-hospital mortality compared with non-ICP-monitored patients.

CONCLUSION: We found that ICP-monitored patients had a lower risk of in-hospital mortality. Our findings support the use of ICP monitors in eligible patients.

Copyright © 2020 Elsevier Inc. All rights reserved.

Language: en

Keywords

ICP monitor; TBI; brain injury; intracranial pressure; outcome