Prognostic Impact of Intracranial Pressure Monitoring After Primary Decompressive Craniectomy for Traumatic Brain Injury

Abstract

Decompressive craniectomy (DC) for traumatic brain injury (TBI) can be used in 2 completely different situations: primary and secondary DC. Although intracranial pressure (ICP) monitoring has proved to be helpful in guiding therapy for head injuries, its role after primary DC is not well analyzed. The aim of this study was to elucidate the relationship between ICP monitoring and outcomes in patients undergoing primary DC for TBI. We enrolled 187 head-injured patients undergoing primary DC in this retrospective study. The patients were subdivided into 2 groups based on whether postoperative ICP was monitored (n= 34) or not (n= 153). We identified the intergroup differences in clinical parameters and prognosis. Unfavorable and favorable neurologic outcomes were defined by Glasgow Outcome Scale scores of 1-3 and 4-5, respectively. The rate of ICP monitoring was 18.2% for our head-injured patients after primary DC. There was no difference in preoperative Glasgow Coma Score, pupil reactivity, features of computed tomography images, or other demographic variables between patients with or without ICP monitoring. The mortality at discharge was 14.7% for patients with ICP monitoring and 32.7% for patients without, which showed a statistically significant difference (P= 0.037). The neurologic outcomes did not differ between the patient groups at discharge or the end of follow-up. Our data suggest that ICP monitoring after primary DC for head-injured patients significantly decreases in-hospital mortality and should be implemented in neurocritical care to ensure the highest chances of surviving TBI.