Page 34 - DECISION-MAKING IN SEVERE TRAUMATIC BRAIN INJURY PATIENT OUTCOME, HOSPITAL COSTS, AND RESEARCH PRACTICE

Chapter 2
Tabel I: ICP Monitoring
Study information
Farahvar (2012)21 USA, 2000-2009 Prospective
Mauritz (2008)22 Austria, 1998-2004 Prospective
Dawes (2015)23 USA, 2009-2010 Prospective
Kim (2014)24 Korea, 2010-2012 Retrospective
Alice (2017)25 USA, 2013-2014 Retrospective
Griesdale (2010)26 Canada, 2000-2006 Retrospective
Haddad (2011)27 Saudi Arabia, 2001-2008 Retrospective
Zeng (2010)28 China, 2004-2006 Retrospective
Purpose
Examine 2-week mortality of s-TBI patients with or without ICP monitor.
Reasons for receiving ICP monitoring and factors influencing mortality.
Determine the impact of ICP monitor placement on inpatient mortality.
Effect of ICP monitoring on the two-week mortality after early DC in s-TBI
Assess both compliance and outcomes of ICP monitoring.
Evaluate guideline adherence and relationship between EVD use and mortality.
Examine outcome of ICP monitoring in s-TBI patients.
Evaluate treatment guided by ICP monitoring in s-TBI patients.
Population
N=1446 ICP:1202 (83.1%) GCS3-5: 761
N=1856 1:ICP:1031 (56%) 2:No-ICP:825 GCS3+4: 959
N=822
ICP: 378 (46%) GCS3: 449
N=78
ICP: 25 (32.1%) GCS3-5: 38 ICP: 10 (26.3%)
N=4880
GCS3-5 sub: 3352 ICP: 381 (11.4%)
N=171
1:EVD: 98 (57%) 2:No EVD: 73 GCS<6: 52
N=477
ICP: 52 (10.9%) GCS3-4: 231
N=136
ICP: 136 (100%) GCS3-5: 58
♂ Age
75 36.6
73 1: 46 2: 53
75 42 82 44 72 50 77 1: 35
2: 42 96 ±28 .5
66 44.8
Table I legend:
* Multivariable logistic regression models predicting 2-week mortality for all-age sample ((OR; 95%CI;P)) ** Risk-adjusted mortality rate reduction for ICP monitoring.
*** Logistic regression analyses predicting 2-week mortalities for all 78 patients.
Abbreviations: ♂: Male; s-TBI: severe Traumatic Brain Injury; ICP: Intracranial Pressure; GCS: Glasgow Coma Scale (score); ICU: Intensive Care Unit; ED: Emergency Department; ISS: Injury Severity Score; FIM: Functional Independence Measure; EVD: External Ventricular Drain; GOS: Glasgow Outcome Scale.
Average reported proportion of ICP monitoring in s-TBI was 42% (range: 10.8-83.1%). Two studies specifically assessed guideline adherence and found only 10.8% and 46% of eligible patients receiving ICP monitoring.23, 25 A third study found that 86% of patients without an extra ventricular drain would have qualified for having one.26 One study investigated inter-center differences and found that ICP monitoring occurred more often in medium-sized trauma centers compared to large centers (OR 3.09, 95% CI 2.42-3.94).22
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