Brain Trauma Foundation Guidelines for Intracranial Pressure Monitoring: Compliance and Effect on Outcome

Intracranial pressure (ICP) monitoring was carried out in 100 patients with severe acute brain trauma, primarily by means of a subarachnoid catheter. Statistical associations were evaluated between maximum ICP values and: 1) Glasgow Coma Scale (GCS) scores; 2) findings on computed tomography (CT) scans of the head; and 3) mortality. A significant association was found between low GCS scores (3 to 5) and high ICP levels, as well as between focal lesions on CT scans and elevated ICP. Mortality was significantly higher in patients with ICP > 40 mm Hg than in those with ICP < 20 mm Hg.

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Is There an Age Cutoff for Intracranial Pressure Monitoring?: A Propensity Score Matched Analysis of the National Trauma Data Bank

The American Surgeon ◽

10.1177/0003134821991985 ◽

2021 ◽

pp. 000313482199198

Author(s):

Anna Liveris ◽

Afshin Parsikia ◽

Jeffrey Melvin ◽

Edward Chao ◽

Srinivas H Reddy ◽

...

Keyword(s):

Intracranial Pressure ◽

Propensity Score ◽

Data Bank ◽

Intracranial Pressure Monitoring ◽

Pressure Monitoring ◽

National Trauma ◽

Brain Trauma Foundation ◽

National Trauma Data Bank ◽

Level 1 ◽

Overall Mortality

Background Despite mostly favorable past evidence for use of intracranial pressure monitoring (ICPM), more recent data question not only the indications but also the utility of ICPM. The Fourth Edition Brain Trauma Foundation guidelines offer limited indications for ICPM. Evidence supports ICPM for reducing mortality in patients with severe traumatic brain injury (TBI) and cites decreased survival in elderly patients. Methods All patients ≥ 18 years of age with isolated TBI, head Abbreviated Injury Scale (AIS) ≥ 3, and a Glasgow Coma Scale (GCS) ≤ 8 between 2008 and 2014 were included from the National Trauma Data Bank. Exclusion criteria were head AIS = 6 and death within 24 hours. Patients with and without ICPM were compared using TBI-specific variables. Patients were then matched via propensity-score matching (PSM), and the odds ratio (OR) of death with ICPM was determined using logistic regression modeling for 8 different age strata. Results A total of 23,652 patients with a mean age of 56 years, median head AIS of 4, median GCS of 3, and overall mortality of 29.2% were analyzed. After PSM, ICPM was associated with death beginning at the age stratum of 56-65 years. Intracranial pressure monitoring was associated with survival beginning at the age-group 36-45 years. Discussion Based on a large propensity-matched sample of TBI patients, ICPM was not associated with improved survival for TBI patients above 55 years of age. Until level 1 evidence is available, this age threshold should be considered for further prospective study in determining indications for ICPM.

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Prognostic significance of intracranial pressure monitoring and intracranial hypertension in severe brain trauma patients

Medicinski pregled ◽

10.2298/mpns1110461k ◽

2011 ◽

Vol 64 (9-10) ◽

pp. 461-465 ◽

Cited By ~ 12

Author(s):

Aleksandar Kostic ◽

Ivan Stefanovic ◽

Vesna Novak ◽

Dragan Veselinovic ◽

Goran Ivanov ◽

...

Keyword(s):

Intracranial Pressure ◽

Intracranial Hypertension ◽

Prognostic Significance ◽

Brain Trauma ◽

Intracranial Pressure Monitoring ◽

Control Group ◽

Trauma Patients ◽

Pressure Monitoring ◽

Prognostic Effect ◽

Significant Difference

Since without prospective randomized studies it is not possible to have a clear attitude towards the importance of intracranial pressure monitoring, this study was aimed at examining the prognostic effect of the intracranial pressure monitoring and intracranial pressure oriented therapy in severe brain trauma patients, and at defining optimal intracranial pressure values for starting the treatment. Two groups of patients were treated in the study, one consisted of 32 patients undergoing intracranial pressure monitoring and the second group of 29 patients without intracranial pressure monitoring in the control group. The study was prospective with groups randomized. There were 53% survivals in the intracranial pressure monitored patients and 34% in the control group, with no significant difference in the survival rate between the two groups (?2=2.11; p=0.15; p>0.05). The average intracranial pressure in the patients with intracranial hypertension who died was 27 mm Hg, while in the patients who survived the average intracranial pressure was significantly lower (Student?s t test: t=2.91; p=0.008; p<0.01) and it was 18 mm Hg. We recommend starting intracranial pressure oriented therapy when the patient?s intracranial pressure exceeds 18 mmHg during 2 hours of monitoring.

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