Therapeutic study, level IV.

No abstract

Background : Intracranial pressure (ICP) monitoring has been recommended as a guiding tool for ICP treatment; however, data suggests invasive ICP monitoring had no better outcomes than those patients without it. We hypothesized that there is no difference in short term outcomes in patients with severe traumatic brain injury (TBI) who received invasive ICP monitoring compared to those who did not. Methods : The trauma registry of a community Level II trauma center was queried from January 2015 to June 2020. Patients with severe TBI identified as Glasgow Coma Scale (GCS) ≤8 upon admission with an abnormal computed tomography (CT) scan, and those meeting Brain Injury Guideline (BIG) 3 (severe) were included. The data was analyzed in a logistic regression model to predict mortality, and a linear model to predict (log-transformed) hospital and ICU length of stay (LOS). Analyses were done in Rv4.0.2software. Results : A total of 7,787 trauma patients were admitted during the study period, 592 were found to have GCS≤8 and of those, 118 met inclusion criteria. Forty-seven percent (n=55) received invasive ICP monitoring and 53 percent (n=63) did not. The majority (n=78, 66%) of patients were male. Median age was 35 for the ICP monitored group and 54 for the group with no ICP monitoring. The median GCS was 3 (IQR= 3,6) and the median ISS was 25 (IQR=17,26 or 27) for both groups. The ICU LOS was 5.3 days and hospital LOS 6.2 days longer for patients with ICP monitor compared to those without ICP monitor (p=0.001). The mortality rate of patients who received an ICP monitor was 19 in 55 (35%) compared to 27 of 63 (42%) for those who did not (p=0.84). Conclusions : Patients with severe traumatic brain injury who received invasive ICP monitors had an increased ICU and hospital length of stay and no mortality difference when compared to those who did not. The use of an ICP monitor did not improve outcomes in this population of severe TBI patients, particularly for those who did not require neurosurgery. Level of Evidence: Level IV