Abstract
BackgroundSeveral observational studies have shown that hospital-level intracranial pressure (ICP) monitoring utilization varies considerably in patients with severe traumatic brain injury (TBI). However, the relationship between hospital-level ICP monitoring utilization and clinical functional outcomes is unknown. This study examined whether patients with severe TBI treated at hospitals with high ICP monitoring utilization have better functional outcomes.MethodsA post hoc analysis of the data from a prospective multicenter cohort study in Japan was undertaken, and included severe TBI patients (Glasgow Come Scale score ≤ 8). The primary exposure was hospital-level ICP monitoring utilization. Patients treated at hospitals with more than 80% ICP monitoring utilization were assigned to a high group and the others to a low group. The primary endpoint was a favorable functional outcome at 6 months after injury, defined as a Glasgow Outcome Scale score of good recovery or moderate disability. We conducted multiple logistic regression analyses adjusted for potential confounders.ResultsOf the 427 included patients, 60 were assigned to the high group and 367 to the low group. Multiple logistic regression analysis revealed that patients in the high group had significantly better functional outcome (adjusted odds ratio [OR]: 2.36; 95% confidence interval [CI]: 1.17–4.76; p = 0.016). Multiple logistic regression analysis adjusted for additional confounders supported this result (adjusted OR: 2.30; 95% CI: 1.07–4.92; p = 0.033).ConclusionTreatment at hospitals with high ICP monitoring utilization for severe TBI patients could be associated with better functional outcome.
Highlights
Several observational studies have shown that hospital-level intracranial pressure (ICP) monitoring utilization varies considerably in patients with severe traumatic brain injury (TBI)
Sixty patients (14%) who were treated at four hospitals with ICP monitoring utilization of more than 80% were assigned to the high group, and the remaining 367 patients were assigned to the low group
Compared with the low group, the high group was more frequently treated with ICP monitoring and at the university hospitals, and had a high proportion of favorable functional outcome
Summary
Several observational studies have shown that hospital-level intracranial pressure (ICP) monitoring utilization varies considerably in patients with severe traumatic brain injury (TBI). The relationship between hospital-level ICP monitoring utilization and clinical functional outcomes is unknown. This study examined whether patients with severe TBI treated at hospitals with high ICP monitoring utilization have better functional outcomes. Elevated intracranial pressure (ICP) commonly occurs during the acute phase of TBI management and is both, a cause and consequence of secondary brain injury that leads to unfavorable functional outcomes [3, 4]. Several observational studies have shown that hospitallevel ICP monitoring utilization for severe TBI varies dramatically [5, 9, 10] and ranges from 9.6 to 65.2%, as reported in a study from Los Angeles [9]. The relationship between hospitallevel ICP monitoring utilization and clinical outcomes is controversial [5, 9]
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