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Intracranial Pressure Monitoring in the Intensive Care Unit for Patients with Severe Traumatic Brain Injury: Analysis of the CENTER-TBI China Registry

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Abstract

Background

Although the current guidelines recommend the use of intracranial pressure (ICP) monitoring in patients with severe traumatic brain injury (sTBI), the evidence indicating benefit is limited. The present study aims to evaluate the impact of ICP monitoring on patients with sTBI in the intensive care unit (ICU).

Methods

The patient data were obtained from the Collaborative European Neurotrauma Effectiveness Research in Traumatic Brain Injury China Registry, a prospective, multicenter, longitudinal, observational, cohort study. Patients with sTBI who were admitted to 52 ICUs across China, managed with ICP monitoring or without, were analyzed in this study. Patients with missing information on discharge survival status, Glasgow Coma Scale score on admission to hospital, and record of ICP monitoring application were excluded from the analysis. Data on demographic characteristics, injury, clinical features, treatments, survival at discharge, discharge destination, and length of stay were collected and assessed. The primary end point was survival state at discharge, and death from any cause was considered the event of interest.

Results

A total of 2029 patients with sTBI were admitted to the ICU; 737 patients (36.32%) underwent ICP monitoring, and 1292 (63.68%) were managed without ICP monitoring. There was a difference between management with and without ICP monitoring on in-hospital mortality in the unmatched cohort (18.86% vs. 26.63%, p < 0.001) and the propensity-score-matched cohort (19.82% vs. 26.83%, p = 0.003). Multivariate logistic regressions also indicated that increasing age, higher injury severity score, lower Glasgow Coma Scale score, unilateral and bilateral pupillary abnormalities, systemic hypotension (SBP ≤ 90 mm Hg), hypoxia (SpO2 < 95%) on arrival at the hospital, and management without ICP monitoring were associated with higher in-hospital mortality. However, the patients without ICP monitoring had a lower length of stay in the ICU (11.79 vs. 7.95 days, p < 0.001) and hospital (25.96 vs. 21.71 days, p < 0.001), and a higher proportion of survivors were discharged to the home with better recovery in self-care.

Conclusions

Although ICP monitoring was not widely used by all of the centers participating in this study, patients with sTBI managed with ICP monitoring show a better outcome in overall survival. Nevertheless, the use of ICP monitoring makes the management of sTBI more complex and increases the costs of medical care by prolonging the patient’s stay in the ICU or hospital.

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Acknowledgements

We would like to thank all clinical investigators and research staff at the CENTER-TBI for their valuable contribution to this study.

Funding

The data used in the preparation of this article were obtained in the context of CENTER-TBI, a large collaborative project with the support of the European Commission 7th Framework program (602150). The work completed in China was supported by the National Natural Science Foundation of China (grants 81971699, 81671198, 82071358, and 81771317), Shanghai Talent Development funding (grant 2018077), and the Program of Shanghai Academic Research Leader (21XD1422400).

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    Authors and Affiliations

    1. Brain Injury Center, Department of Neurosurgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China

      Chun Yang, Yuxiao Ma, Jiyuan Hui, Jiyao Jiang & Junfeng Feng

    2. Shanghai Institute of Head Trauma, Shanghai, China

      Chun Yang, Yuxiao Ma, Jiyuan Hui, Jiyao Jiang & Junfeng Feng

    3. Clinical Research Institute, Shanghai Jiao Tong University School of Medicine, Shanghai, China

      Li Xie

    4. Department of Neurosurgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China

      Xiang Wu & Guoyi Gao

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    Contributions

    GG, JJ, and JF contributed to study concept and design. CY, XW, and LX contributed to data acquisition and analysis. CY and YM drafted the manuscript and figures. JF and CY contributed to the manuscript’s critical revision. All authors reviewed and approved the final version of the paper.

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    Yang, C., Ma, Y., Xie, L. et al. Intracranial Pressure Monitoring in the Intensive Care Unit for Patients with Severe Traumatic Brain Injury: Analysis of the CENTER-TBI China Registry. Neurocrit Care 37, 160–171 (2022). https://doi.org/10.1007/s12028-022-01463-w

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