Abstract
BackgroundAlthough international guideline recommended routine intracranial pressure (ICP) monitoring for patients with severe traumatic brain injury(TBI), there were conflicting outcomes attributable to ICP monitoring according to the published studies. Hence, we conducted a meta-analysis to evaluate the efficacy and safety of ICP monitoring in patients with TBI.MethodsBased on previous reviews, PubMed and two Chinese databases (Wangfang and VIP) were further searched to identify eligible studies. The primary outcome was mortality. Secondary outcomes included unfavourable outcome, adverse events, length of ICU stay and length of hospital stay. Weighted mean difference (WMD), odds ratio (OR) and 95% confidence intervals (CIs) were calculated and pooled using fixed-effects or random-effects model.Resultstwo randomized controlled trials (RCTs) and seven cohort studies involving 11,038 patients met the inclusion criteria. ICP monitoring was not associated with a significant reduction in mortality (OR, 1.16; 95% CI, 0.87–1.54), with substantial heterogeneity (I2 = 80%, P<0.00001), which was verified by the sensitivity analyses. No significant difference was found in the occurrence of unfavourable outcome (OR, 1.40; 95% CI, 0.99–1.98; I2 = 4%, P = 0.35) and advese events (OR, 1.04; 95% CI, 0.64–1.70; I2 = 78%, P = 0.03). However, we should be cautious to the result of adverse events because of the substantial heterogeneity in the comparison. Furthermore, longer ICU and hospital stay were the consistent tendency according to the pooled studies.ConclusionsNo benefit was found in patients with TBI who underwent ICP monitoring. Considering substantial clinical heterogeneity, further large sample size RCTs are needed to confirm the current findings.
Highlights
Traumatic brain injury (TBI) is the leading cause of death and disability after serious injury, an average of 235,000 hospitalizations and 50,000 deaths occurring each year in United States [1]
The guideline from Brain Trauma Foundation (BTF) recommended intracranial pressure (ICP) monitoring for patients with severe TBI (Glasgow Coma Scale (GCS) score #8 ) and an abnormal brain computerized tomography (CT) scan
Biersteker et al [12] and Thompson et al [13] presented that ICP monitoring was not associated with mortality and unfavorable outcome, which was consistent with Cremer and colleagues [14]
Summary
Traumatic brain injury (TBI) is the leading cause of death and disability after serious injury, an average of 235,000 hospitalizations and 50,000 deaths occurring each year in United States [1]. The management of patients with TBI would benefit from ICP monitoring [4]. The guideline from Brain Trauma Foundation (BTF) recommended ICP monitoring for patients with severe TBI (Glasgow Coma Scale (GCS) score #8 ) and an abnormal brain computerized tomography (CT) scan. ICP monitoring was recommended for patients with severe TBI without CT abnormalities but with at least two of the following criteria: age .40 years, motor posturing, or systolic blood pressure , 90 mm Hg [5]. The efficacy and safety of ICP monitoring following TBI still remains controversial. International guideline recommended routine intracranial pressure (ICP) monitoring for patients with severe traumatic brain injury(TBI), there were conflicting outcomes attributable to ICP monitoring according to the published studies.
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