Role of invasive ICP monitoring in patients with traumatic brain injury: An experience of 98 cases

Abstract

The outcome of patients with head injury depends upon several factors, and most important among them is the raised intracranial pressure. ICP monitoring using subdural Richmond bolt system was used in 98 cases of TBI. The age range was 9–75 years; there were 78 adults and 20 children. This included 52 cases of severe HI and 46 cases with moderate HI.The GCS range was 4–10(mean: 5.6). Mortality was 64% in severe HI (34/52) and 9.5% in moderate HI patients (4/42). ICP ranged from 6–28mm Hg in moderate HI (mean 11.6 mm) and 8–42mm Hg in severe HI (mean 19.6 mmHg). Of 98 cases of HI, 41(41.8%) patients were operated (26 had moderate HI and 15 cases had severe HI. Seventy-three (74.5%) cases had single/multiple contusions in frontal/temporal regions while 25/73(25.5%) patients had diffuse axonal injury (10 cases) and thin subdural hematoma (15 cases). Fifty-seven patients were managed conservatively with decongestants, elective ventilation and continuous ICP monitoring for 3 days. Of these, 16(43%) had moderate HI and 41(71%) cases had severe HI. In the absence of intracranial hypertension (ICP <10 mm Hg), good recovery (Glasgow outcome scale: 4–5) was noted in 8/57(14%) cases in conservative group and in 4/41(9.7%)cases in operative group. In patients with ICP in 11–20 mm range, good recovery was noted in 6/41(14.6%) patients in operative group and in 9/ 57(15.8%) patients managed conservatively. When the ICP was >20 mm Hg, 10/41(24.3%) operated patients expired while only 6/57(10.5%) patients in conservative group expired. ICP malfunction after day 1 was noted in 27 cases ((27.5%) while ICP site infection/CSF leak was noted in 8 cases (8.2%). Outcome was related to severity of head injury and intracranial hypertension. Outcome was better in patients of moderate HI after surgery than in severe HI patients. Mortality was higher in patients operated in the presence of intracranial hypertension than in those managed conservatively. ICP monitoring was associated with a high blockage (27.5%) and infection rate (8.2%). ICP monitoring improved overall outcome in moderate head injury patients.