Advertisement

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

Abstract

Background

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.

Methods

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.

Results

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).

Conclusions

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.

Keywords

Traumatic Brain Injury Severe Traumatic Brain Injury Abbreviate Injury Scale Brain Trauma Foundation Head Abbreviate Injury Scale 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Compliance with ethical standards

Conflict of interest

All authors deny any potential conflicts of interest.

References

  1. 1.
    Mendelson AA, Gillis C, Henderson WR et al (2012) Intracranial pressure monitors in traumatic brain injury: a systematic review. Can J Neurol Sci 39:571–576CrossRefPubMedGoogle Scholar
  2. 2.
    Farahvar A, Gerber LM, Chiu YL et al (2012) Increased mortality in patients with severe traumatic brain injury treated without intracranial pressure monitoring. J Neurosurg 117:729–734CrossRefPubMedGoogle Scholar
  3. 3.
    Lobato RD, Sarabia R, Rivas JJ et al (1986) Normal computerized tomography scans in severe head injury. Prognostic and clinical management implications. J Neurosurg 65:784–789CrossRefPubMedGoogle Scholar
  4. 4.
    Narayan RK, Kishore PR, Becker DP et al (1982) Intracranial pressure: to monitor or not to monitor? A review of our experience with severe head injury. J Neurosurg 56:650–659CrossRefPubMedGoogle Scholar
  5. 5.
    Bratton SL, Chestnut RM, Ghajar  J et al (2007) Guidelines for the management of severe traumatic brain injury. VI. Indications for intracranial pressure monitoring. J Neurotrauma 24(Suppl 1):S37–S44PubMedGoogle Scholar
  6. 6.
    You W, Feng J, Tang Q et al (2016) Intraventricular intracranial pressure monitoring improves the outcome of older adults with severe traumatic brain injury: an observational, prospective study. BMC Anesthesiol 16:35CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Cremer OL, van Dijk GW, van Wensen E et al (2005) Effect of intracranial pressure monitoring and targeted intensive care on functional outcome after severe head injury. Crit Care Med 33:2207–2213CrossRefPubMedGoogle Scholar
  8. 8.
    Shafi S, Diaz-Arrastia R, Madden C et al (2008) Intracranial pressure monitoring in brain-injured patients is associated with worsening of survival. J Trauma 64:335–340CrossRefPubMedGoogle Scholar
  9. 9.
    Dawes AJ, Sacks GD, Cryer HG et al (2015) Compliance with evidence-based guidelines and interhospital variation in mortality for patients with severe traumatic brain injury. JAMA Surg 150:965–972CrossRefPubMedGoogle Scholar
  10. 10.
    Agrawal D, Raghavendran K, Schaubel DE et al (2016) A propensity score analysis of the impact of invasive intracranial pressure monitoring on outcomes after severe traumatic brain injury. J Neurotrauma 33:853–858CrossRefPubMedGoogle Scholar
  11. 11.
    Haddad S, Aldawood AS, Alferayan A et al (2011) Relationship between intracranial pressure monitoring and outcomes in severe traumatic brain injury patients. Anaesth Intensive Care 39:1043–1050PubMedGoogle Scholar
  12. 12.
    Dawes AJ, Sacks GD, Cryer HG et al (2015) Intracranial pressure monitoring and inpatient mortality in severe traumatic brain injury: a propensity score-matched analysis. J Trauma Acute Care Surg 78:492–501CrossRefPubMedGoogle Scholar
  13. 13.
    Chesnut RM, Temkin N, Carney N et al (2012) A trial of intracranial-pressure monitoring in traumatic brain injury. N Engl J Med 367:2471–2781CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Talving P, Karamanos E, Teixeira PG et al (2013) Intracranial pressure monitoring in severe head injury: compliance with Brain Trauma Foundation guidelines and effect on outcomes: a prospective study. J Neurosurg 119:1248–1254CrossRefPubMedGoogle Scholar
  15. 15.
    Lane PL, Skoretz TG, Doig G et al (2000) Intracranial pressure monitoring and outcomes after traumatic brain injury. Can J Surg 43:442–448PubMedPubMedCentralGoogle Scholar
  16. 16.
    Stein SC, Georgoff P, Meghan S et al (2010) Relationship of aggressive monitoring and treatment to improved outcomes in severe traumatic brain injury. J Neurosurg 112:1105–1112CrossRefPubMedGoogle Scholar

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

Personalised recommendations