Intracranial pressure monitoring following traumatic brain injury: evaluation of indications, complications, and significance of follow-up imaging—an exploratory, retrospective study of consecutive patients at a level I trauma center

Abstract

Background Measurement of intracranial pressure (ICP) is an essential part of clinical management of severe traumatic brain injury (TBI). However, clinical utility and impact on clinical outcome of ICP monitoring remain controversial. Follow-up imaging using cranial computed tomography (CCT) is commonly performed in these patients. This retrospective cohort study reports on complication rates of ICP measurement in severe TBI patients, as well as on findings and clinical consequences of follow-up CCT. Methods We performed a retrospective clinical chart review of severe TBI patients with invasive ICP measurement treated at an urban level I trauma center between January 2007 and September 2017. Results Clinical records of 213 patients were analyzed. The mean Glasgow Coma Scale (GCS) on admission was 6 with an intra-hospital mortality of 20.7%. Overall, complications in 12 patients (5.6%) related to the invasive ICP-measurement were recorded of which 5 necessitated surgical intervention. Follow-up CCT scans were performed in 192 patients (89.7%). Indications for follow-up CCTs included routine imaging without clinical deterioration (n = 137, 64.3%), and increased ICP values and/or clinical deterioration (n = 55, 25.8%). Follow-up imaging based on clinical deterioration and increased ICP values were associated with significantly increased likelihoods of worsening of CCT findings compared to routinely performed CCT scans with an odds ratio of 5.524 (95% CI 1.625–18.773) and 6.977 (95% CI 3.262–14.926), respectively. Readings of follow-up CCT imaging resulted in subsequent surgical intervention in six patients (3.1%). Conclusions Invasive ICP-monitoring in severe TBI patients was safe in our study population with an acceptable complication rate. We found a high number of follow-up CCT. Our results indicate that CCT imaging in patients with invasive ICP monitoring should only be considered in patients with elevated ICP values and/or clinical deterioration.

Prediction of Intracranial Pressure in Patients with an Aneurysmal Subarachnoid Hemorrhage Using Optic Nerve Sheath Diameter via Explainable Predictive Modeling

“…However, the generally accepted range for individuals in the supine position is 7.5 to 20 cmH 2 O in healthy adults [2]. In this investigation, the criteria for increased ICP (IICP) were delineated at 20 and 25 cmH 2 O, considering diverse reference values reported in previous studies [3,20,21].…”

A review of invasive intracranial pressure monitoring following surgery for hypertensive cerebral hemorrhage

“…Furthermore, invasive intracranial pressure monitoring reduces the number of cranial CT scans performed on patients with increased intracranial pressure or those with a declining level of consciousness. This, in turn, lowers the number of patient evacuations and the hazards associated with transportation ( 18 ). A meta-analysis demonstrated that aggressive intracranial pressure monitoring and treatment resulted in a better prognosis for patients ( 19 ).…”