Abstract WP455: Intracranial Pressure Monitoring in Patients With Spontaneous Intracerebral Hemorrhage

Abstract

Objective: The role of ICP monitoring in patients with spontaneous ICH is unknown, andthe associated complications may offset its benefits. The aim of the study was to compare the outcomes of ICH patients who underwent ICP monitoring to those who were managed by care-guided imaging and/or clinical exam alone. Methods: This was aretrospective, matched cohort analysis from a multicenter, prospective study with recruitment of 3,000 multi-ethnic cases of spontaneous ICH between September 2010 and October 2015. ICH patients with ICP monitoring were propensity-score matched, in a 1:1 ratio, to those without ICP monitoring. The primary outcome was mortality at 90 days. Secondary outcomes were in-hospital mortality, use of hyperosmolar (mannitol or hypertonic saline) therapy, surgical ICH evacuation, length of hospital stay, and the following 90-day outcomes: modified Rankin Scale (mRS) excellent (0-1) and good (0-2), Barthel Index, and health-related quality of life (HRQoL) (EuroQol Group 5-Dimension [EQ-5D] and EQ-5D Visual Analog Scale [VAS] scores). Results: The ICP and no ICP monitoring cohorts comprised 566 and 2,434 patients, respectively. The matched cohorts each included 420 patients. The 90-day and in-hospital mortality rates were similar between the matched cohorts. Infection rate was higher in the ICP monitoring cohort (5.7% vs. 1.2%, aOR=5.066, p=0.001).Shift analysis 90-day mRS favored no ICP monitoring (aOR=1.628, p<0.001). The following outcomes were lower in the ICP monitoring cohort: excellent (6% vs. 15%; aOR=0.375, p<0.001) and good (16% vs. 30%; aOR=0.465, p<0.001) outcome, Barthel Index (median 15 vs. 45; aβ=-12.050, p<0.001), EQ-5D score (median 0.178 vs. 0.437; aβ=-0.064, p=0.026), and ED-5Q VAS score (median 40 vs. 50; aβ=-6.662, p=0.004) at 90 days. In a subgroup analysis of patients with admission GCS score ≤8, despite lower EQ-5D scores at 90 days in the ICP monitoring cohort, no difference in 90-day mortality, in-hospital mortality, excellent or good outcome, 90-day of mRS scores, ED-5Q VAS scores, and Barthel Index were observed between the ICP and no ICP monitoring cohorts. Conclusion: The findings of this study do not support the routine utilization of ICP monitoring in patients with ICH.