Abstract
Brain Trauma Foundation (BTF) guidelines recommend intracranial pressure (ICP) monitoring in patients who sustained severe traumatic brain injury (TBI). Compliance to BTF guidelines is variable, and the effect of ICP monitoring on outcomes remains a controversial issue. The purpose of this study was to assess guidelines compliance in patients who sustain a severe TBI and to analyze the effect of ICP monitoring on outcomes. Trauma Quality Improvement Program database study, which included patients with isolated severe blunt head trauma (head Abbreviated Injury Scale ≥3 with Glasgow Coma Scale <9). Patients with severe extracranial injuries excluded. Analyzed variables were demographics, comorbidities, mechanism of injuries, head injury specifics, AIS for each body area, Injury Severity Score, admission vital signs, placement of ICP catheter and craniectomy. Multivariate analysis was used to identify independent predictors for outcomes, overall and in the groups of patients with head AIS 3, 4 or 5. During the study period 13,188 patients with isolated severe TBI met the BTF guidelines for ICP monitoring. An ICP catheter was placed in 1519 (11.5%) patients. Stepwise logistic regression analysis identified age ≥65years, hypotension on admission, AIS 4 and AIS 5 as independent predictors for mortality. ICP monitoring was not an independent protective variable in terms of mortality (OR 1.12; 95% CI, 0.983-1.275; p=0.088). Overall, ICP monitor placement was independently associated with increased overall complications (OR 2.089; 95% CI, 1.85-2.358; p<0.001), infectious complications (OR 2.282; 95% CI, 2.015-2.584; p<0.001) and poor functional independence (OR 1.889; 95% CI, 1.575-2.264; p<0.001). Sub analysis of the groups of patients with head AIS 3, 4, and 5 failed to show any protective effect of ICP monitors against mortality. In the group of patients with head AIS 4, ICP placement was an independent predictor of mortality (OR 2206; 95% CI, 1652-2948; p<0.001). Compliance with the BTF guidelines for ICP monitoring is poor. ICP monitoring does not have any survival benefit in patients with isolated severe blunt TBI and is associated with more complications and increased utilization of hospital resources.
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Disclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.