scholarly journals Adherence to brain trauma foundation guidelines for intracranial pressure monitoring in severe traumatic brain injury and the effect on outcome: A population-based study

2020 ◽  
Vol 11 ◽  
pp. 118
Author(s):  
Yahya H. Khormi ◽  
Ambikaipakan Senthilselvan ◽  
Cian O’kelly ◽  
David Zygun
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Intracranial Pressure ◽  
Severe Traumatic Brain Injury ◽  
Alcohol Intoxication ◽  
Brain Trauma ◽  
Adherence Rate ◽  
Icp Monitoring ◽  
Brain Trauma Foundation ◽  
Severity Scores

Background: Severe traumatic brain injury (TBI) is a significant cause of death and disability. The objective of this study was to provide an overview of whether adherence to brain trauma foundation (BTF) guidelines improved outcomes following TBI utilizing intracranial pressure (ICP) monitoring. Methods: This cohort study between 2000 and 2013 involved 1848 patients who sustained severe blunt TBI. Outcomes were correlated with whether or not ICP monitoring was utilized based on BTF guidelines. Results: The BTF guideline adherence rate for utilizing ICP monitoring in patients with TBI was 30% in 1848 patients. Adherence rates positively correlated with younger age, high injury severity scores, lower Glasgow Coma Scores, abnormal computed tomography scans of the head, performance of a craniotomy, neurocritical care unit admission, the lack of alcohol intoxication, and the absence of a cardiac arrest. Greater adherence to BTF guidelines was associated with higher mortality rates (OR 2.01, 95% CI: 1.56–2.59, P < 0.001), and increase ICU and hospital lengths of stay (P < 0.001). Conclusion: Adherence rates to BTF guidelines for ICP monitoring in patients with severe TBI were low. Further, these rates varied across centers and were correlated with higher mortality and morbidity rates. Although ICP insertion may be an indicator of TBI severity, the current BTF criteria for insertion of ICP monitors may fail to identify patients likely to benefit.

scholarly journals Increased mortality in patients with severe traumatic brain injury treated without intracranial pressure monitoring

2012 ◽  
Vol 117 (4) ◽  
pp. 729-734 ◽  
Author(s):  
Arash Farahvar ◽  
Linda M. Gerber ◽  
Ya-Lin Chiu ◽  
Nancy Carney ◽  
Roger Härtl ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Intracranial Pressure ◽  
Intracranial Hypertension ◽  
Severe Traumatic Brain Injury ◽  
Lower Mortality ◽  
Icp Monitoring ◽  
Improvement Program ◽  
Severe Tbi ◽  
Gcs Score

Object Evidence-based guidelines recommend intracranial pressure (ICP) monitoring for patients with severe traumatic brain injury (TBI), but there is limited evidence that monitoring and treating intracranial hypertension reduces mortality. This study uses a large, prospectively collected database to examine the effect on 2-week mortality of ICP reduction therapies administered to patients with severe TBI treated either with or without an ICP monitor. Methods From a population of 2134 patients with severe TBI (Glasgow Coma Scale [GCS] Score <9), 1446 patients were treated with ICP-lowering therapies. Of those, 1202 had an ICP monitor inserted and 244 were treated without monitoring. Patients were admitted to one of 20 Level I and two Level II trauma centers, part of a New York State quality improvement program administered by the Brain Trauma Foundation between 2000 and 2009. This database also contains information on known independent early prognostic indicators of mortality, including age, admission GCS score, pupillary status, CT scanning findings, and hypotension. Results Age, initial GCS score, hypotension, and CT scan findings were associated with 2-week mortality. In addition, patients of all ages treated with an ICP monitor in place had lower mortality at 2 weeks (p = 0.02) than those treated without an ICP monitor, after adjusting for parameters that independently affect mortality. Conclusions In patients with severe TBI treated for intracranial hypertension, the use of an ICP monitor is associated with significantly lower mortality when compared with patients treated without an ICP monitor. Based on these findings, the authors conclude that ICP-directed therapy in patients with severe TBI should be guided by ICP monitoring.

Intracranial Pressure Monitoring in Severe Traumatic Brain Injury

2018 ◽  
pp. 39-44
Author(s):  
Thomas Peponis ◽  
David R. King
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Intracranial Pressure ◽  
Severe Traumatic Brain Injury ◽  
Controlled Trial ◽  
Survival Rates ◽  
Intracranial Pressure Monitoring ◽  
Icp Monitoring ◽  
Pressure Monitoring ◽  
Neuropsychological Status

The study “A Trial of Intracranial-Pressure Monitoring in Traumatic Brain Injury” published by Chesnut et al. aimed to resolve the debatable issue of the benefit of intracranial-pressure (ICP) monitoring in patients with severe traumatic brain injury (TBI). The authors designed a randomized controlled trial that was conducted in Latin America. A total of 324 patients admitted with severe TBI were randomly assigned to two groups. The first group (n = 157) was managed with ICP monitoring, using an intraparenchymal monitor. The goal was to keep the ICP below 20 mm Hg. Management of patients comprising the second group (n = 167) was based solely on serial clinical examinations and imaging tests. It was hypothesized that ICP-monitoring would result in increased survival rates, plus improved functional and neuropsychological status at 6-months after the injury. Additionally, the authors hypothesized that complication rates would be decreased and the ICU length of stay shorter.

Correlation Between Brain Trauma Foundation Guidelines and Published Severe Traumatic Brain Injury Research

2020 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Abhijit V. Lele ◽  
Puriwat To-adithep ◽  
Phuriphong Chanthima ◽  
Viharika Lakireddy ◽  
Monica S. Vavilala
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Severe Traumatic Brain Injury ◽  
Brain Trauma ◽  
Brain Trauma Foundation ◽  
Injury Research

scholarly journals Prognostic Impact of Intracranial Pressure Monitoring in Patients with Severe Traumatic Brain Injury

2018 ◽  
Vol 37 (04) ◽  
pp. 291-296
Author(s):  
Bárbara Borchardt ◽  
Luanna Freitas ◽  
Ademar Filho ◽  
Áurea da Rosa ◽  
Milena Gabe ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Intracranial Pressure ◽  
Severe Traumatic Brain Injury ◽  
Total Sample ◽  
Common Finding ◽  
Prognostic Impact ◽  
Icp Monitoring ◽  
Severe Tbi ◽  
Improvement In Survival

Objectives The aim of the present study was to analyze the prognostic impact of intracranial pressure (ICP) monitoring in patients with severe traumatic brain injury (TBI). Methods An observational, retrospective and quantitative study was performed. The sample consisted of 246 patients diagnosed with severe TBI, from January 2009 to August 2017. Results Out of the total sample, 43.56% of the patients were submitted to ICP monitoring. The mean time of use of the catheter was 1.7 days. In both groups, males were the most affected, and the majority of the patients were < 50 years old. Automobile accident was the main etiology of TBI. In the initial clinical evaluation, mydriatic pupils were related to death and normal pupil reaction at hospital discharge. The monitored group performed a larger number of computed tomography (CT) scans, with a mean of 2.6 examinations, with cerebral edema being the most common finding. Regarding the prognosis, those who used a catheter for ICP monitoring had a 47% reduction in the chance of death when compared with those who did not use the catheter. The stay duration both in the hospital and in the intensive care units was higher in patients who underwent ICP monitoring; periods > 30 days were related to meningitis, especially in those who used the catheter. Conclusion Patients who used a catheter for ICP monitoring had a significant improvement in survival.

scholarly journals External Ventricular Drains and Mortality in Patients with Severe Traumatic Brain Injury

2010 ◽  
Vol 37 (1) ◽  
pp. 43-48 ◽  
Author(s):  
Donald E. G. Griesdale ◽  
Jonathan McEwen ◽  
Tobias Kurth ◽  
Dean R. Chittock
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Severe Traumatic Brain Injury ◽  
External Ventricular Drain ◽  
Strong Association ◽  
Icp Monitoring ◽  
Brain Trauma Foundation ◽  
Adjusted Logistic Regression ◽  
Gcs Score

Purpose:To determine our institutional adherence to the Brain Trauma Foundation guidelines with respect to intracranial pressure (ICP) monitoring, and examine the relationship between external ventricular drain (EVD) use and mortality.Materials & Methods:Retrospective cohort study of 171 patients with severe traumatic brain injury (TBI). Propensity score adjusted logistic regression was used to model the association between EVD use and mortality.Results:EVDs were inserted in 98 of 171 patients. Of the 73 patients without an EVD, 63 (86%) would have qualified for ICP monitoring under the current guidelines. EVDs werein situfor a median of 8 days (SD 6). In adjusted analyses, EVD use was associated with hospital mortality (OR 2.8, 95% CI: 1.1 - 7.1, p=0.04) and 28-day mortality (OR 2.1, 95% CI: 0.80 - 5.6, p=0.13). We observed significant modification of the association between EVD and 28-day mortality by GCS within 12 hours (p-interaction = 0.04), indicating strong association only among those patients with GCS score of at least 6 (OR 5.0, 95% CI: 1.5 - 16.7, p<0.01).Conclusions:The association of EVD with 28-day mortality was only apparent among patients with GCS score of ≥ 6. Further research is warranted to further refine which patients may benefit from ICP monitoring.

scholarly journals Respect your elders: effects of ageing on intracranial pressure monitor use in traumatic brain injury

2019 ◽  
Vol 4 (1) ◽  
pp. e000306 ◽  
Author(s):  
Alexander J Schupper ◽  
Allison E Berndtson ◽  
Alan Smith ◽  
Laura Godat ◽  
Todd W Costantini
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Intracranial Pressure ◽  
Injury Severity ◽  
Demographic Data ◽  
Multivariable Analysis ◽  
Brain Trauma ◽  
Hospital Length Of Stay ◽  
Level Of Evidence ◽  
Brain Trauma Foundation

BackgroundThe Brain Trauma Foundation recommends intracranial pressure (ICP) monitor placement for patients with severe traumatic brain injury (TBI). Adherence with these guidelines in elderly patients is unknown. We hypothesized that disparities in ICP monitor placement would exist based on patient age.MethodsUsing the National Trauma Data Bank (2010–2014), we identified patients admitted for blunt TBI with admission Glasgow Coma Scale (GCS) scores of 3–8. Patients were excluded if they had a non-Head Abbreviated Injury Scale (AIS) score ≥3, hospital length of stay <24 hours or were discharged from the emergency department. Demographic data, ICP monitor placement, GCS, AIS-Head, Injury Severity Score, and outcome measures were collected. Propensity score matching between ICP monitor and non-ICP monitor patients was used for logistic regression and Cox multivariate regression analyses.ResultsOf the 30 710 patients with blunt TBI with GCS scores of 3–8 included in our study, 4093 were treated with an ICP monitor. ICP monitor placement rates significantly decreased with increasing age. Multivariable analysis demonstrated that patients treated with an ICP monitor were more likely to be younger, male, have private/commercial insurance, and receive care at an institution with three or more neurosurgeons.ConclusionPatients ≥65 years of age with severe blunt TBI are less likely to be treated with an ICP monitor than younger patients. Age disparities in adherence to Brain Trauma Foundation guidelines may alter the outcomes for patients with severe TBI.Level of evidenceLevel IV.

scholarly journals Mannitol dosing error during interfacility transfer for intracranial emergencies

2015 ◽  
Vol 123 (5) ◽  
pp. 1166-1169 ◽  
Author(s):  
Cameron A. Elliott ◽  
Mark MacKenzie ◽  
Cian J. O’Kelly
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Glasgow Coma Scale ◽  
Scale Score ◽  
Severe Traumatic Brain Injury ◽  
Glasgow Coma Scale Score ◽  
Brain Trauma ◽  
Coma Scale ◽  
Dosing Error ◽  
Brain Trauma Foundation

OBJECT Mannitol is commonly used to treat elevated intracranial pressure (ICP). The authors analyzed mannitol dosing errors at peripheral hospitals prior to or during transport to tertiary care facilities for intracranial emergencies. They also investigated the appropriateness of mannitol use based on the 2007 Brain Trauma Foundation guidelines for severe traumatic brain injury. METHODS The authors conducted a retrospective review of the Shock Trauma Air Rescue Society (STARS) electronic patient database of helicopter medical evacuations in Alberta, Canada, between 2004 and 2012, limited to patients receiving mannitol before transfer. They extracted data on mannitol administration and patient characteristics, including diagnosis, mechanism, Glasgow Coma Scale score, weight, age, and pupil status. RESULTS A total of 120 patients with an intracranial emergency received a mannitol infusion initiated at a peripheral hospital (median Glasgow Coma Scale score 6; range 3–13). Overall, there was a 22% dosing error rate, which comprised an underdosing rate (< 0.25 g/kg) of 8.3% (10 of 120 patients), an overdosing rate (> 1.5 g/kg) of 7.5% (9 of 120), and a nonbolus administration rate (> 1 hour) of 6.7% (8 of 120). Overall, 72% of patients had a clear indication to receive mannitol as defined by meeting at least one of the following criteria based on Brain Trauma Foundation guidelines: neurological deterioration (11%), severe traumatic brain injury (69%), or pupillary abnormality (25%). CONCLUSIONS Mannitol administration at peripheral hospitals is prone to dosing error. Strategies such as a pretransport checklist may mitigate this risk.

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