Directions for Use of Intracranial Pressure Monitoring in the Treatment of Severe Traumatic Brain Injury Using Data from The Japan Neurotrauma Data Bank.

Abstract

Neuromonitoring can be used to observe intracranial pathological conditions in neurointensive care; however, use of intracranial pressure (ICP) monitoring is low in Japan. In this study, we retrospectively investigated the effects of ICP monitoring in the treatment of severe traumatic brain injury (TBI), using data from the Japan Neurotrauma Data Bank (JNTDB). The study was conducted in 1091 subjects enrolled in the JNTDB (Project 2009) from July 2009 to June 2011. The subjects were divided into those treated with and treated without ICP monitoring in intensive care for severe TBI. Age at admission, sex, level of consciousness (Glasgow Coma Scale [GCS] score), pupillary findings, findings on head CT, treatment, and outcome were compared between these groups. The subjects were also classified into two groups based on the outcome. Relationships among patient background factors, including ICP and clinical outcome were evaluated. The rate of ICP monitoring in treatment of severe TBI was 28%. Therapies were performed aggressively in the ICP monitoring group, and this group had a significant reduction in mortality, but no increase in the favorable outcome rate. In multivariate analysis, age, GCS, pupillary abnormalities, perimesencephalic cistern disappearance or compression, and ICP were associated with a favorable outcome, but the therapeutic method did not affect outcome. We conclude that ICP monitoring and management of ICP are both important for management and care of severe TBI. However, current therapies do not control ICP sufficiently, and more effective therapies are needed.