World Journal of Surgery

, Volume 41, Issue 6, pp 1543–1549 | Cite as

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

  • Alberto Aiolfi
  • Elizabeth Benjamin
  • Desmond Khor
  • Kenji Inaba
  • Lydia Lam
  • Demetrios DemetriadesEmail author
Original Scientific Report



Brain Trauma Foundation (BTF) guidelines recommend intracranial pressure (ICP) monitoring in patients who sustained severe traumatic brain injury (TBI). Compliance to BTF guidelines is variable, and the effect of ICP monitoring on outcomes remains a controversial issue. The purpose of this study was to assess guidelines compliance in patients who sustain a severe TBI and to analyze the effect of ICP monitoring on outcomes.


Trauma Quality Improvement Program database study, which included patients with isolated severe blunt head trauma (head Abbreviated Injury Scale ≥3 with Glasgow Coma Scale <9). Patients with severe extracranial injuries excluded. Analyzed variables were demographics, comorbidities, mechanism of injuries, head injury specifics, AIS for each body area, Injury Severity Score, admission vital signs, placement of ICP catheter and craniectomy. Multivariate analysis was used to identify independent predictors for outcomes, overall and in the groups of patients with head AIS 3, 4 or 5.


During the study period 13,188 patients with isolated severe TBI met the BTF guidelines for ICP monitoring. An ICP catheter was placed in 1519 (11.5%) patients. Stepwise logistic regression analysis identified age ≥65 years, hypotension on admission, AIS 4 and AIS 5 as independent predictors for mortality. ICP monitoring was not an independent protective variable in terms of mortality (OR 1.12; 95% CI, 0.983–1.275; p = 0.088). Overall, ICP monitor placement was independently associated with increased overall complications (OR 2.089; 95% CI, 1.85–2.358; p < 0.001), infectious complications (OR 2.282; 95% CI, 2.015–2.584; p < 0.001) and poor functional independence (OR 1.889; 95% CI, 1.575–2.264; p < 0.001). Sub analysis of the groups of patients with head AIS 3, 4, and 5 failed to show any protective effect of ICP monitors against mortality. In the group of patients with head AIS 4, ICP placement was an independent predictor of mortality (OR 2206; 95% CI, 1652–2948; p < 0.001).


Compliance with the BTF guidelines for ICP monitoring is poor. ICP monitoring does not have any survival benefit in patients with isolated severe blunt TBI and is associated with more complications and increased utilization of hospital resources.


Traumatic Brain Injury Severe Traumatic Brain Injury Abbreviate Injury Scale Brain Trauma Foundation Head Abbreviate Injury Scale 
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Compliance with ethical standards

Conflict of interest

All authors deny any potential conflicts of interest.


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Copyright information

© Société Internationale de Chirurgie 2017

Authors and Affiliations

  • Alberto Aiolfi
    • 1
  • Elizabeth Benjamin
    • 1
  • Desmond Khor
    • 1
  • Kenji Inaba
    • 1
  • Lydia Lam
    • 1
  • Demetrios Demetriades
    • 1
    Email author
  1. 1.Division of Acute Care SurgeryUniversity of Southern CaliforniaLos AngelesUSA

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