Intracranial pressure monitoring and case mix-adjusted mortality in intracranial hemorrhage.
OBJECTIVE
Intracranial pressure (ICP) monitoring is frequently used in intensive care treatment of patients with intracranial hemorrhage. Data demonstrating an improved outcome from this intervention are lacking. We analyzed standardized mortality ratios in patients with and without ICP monitoring to determine its efficacy.


METHODS
A nonrandomized study of case records of consecutively admitted intensive care unit (ICU) patients with intracranial hemorrhage.


METHODS
General and medical ICU of a 900-bed tertiary-care hospital.


METHODS
A total of 225 patients with intracranial hemorrhage (mainly nontraumatic) admitted consecutively between April 1997 and March 2000.


METHODS
Simplified Acute Physiology Score (SAPS) II, diagnosis, age, sex, use of ICP monitoring, and in-hospital mortality rates were collected from the hospital's ICU database. Expected mortality was provided by means of SAPS II. Standardized mortality ratios were calculated and compared in 119 patients with ICP monitoring and 106 patients without ICP monitoring.


RESULTS
The case mix-adjusted hospital mortality in the group with ICP monitoring was in the expected range (standardized mortality ratio, 1.09 [95% confidence interval (CI), 0.87-1.31]). Patients without ICP monitoring had a significantly higher standardized mortality ratio than expected (1.26 [95% CI, 1.06-1.46]).


CONCLUSIONS
A beneficial effect of ICP monitoring in patients with intracranial hemorrhage may be reflected in an improved standardized mortality ratio.
Valentin
Andreas
A
II Medical Department, University of Vienna, Austria.
Lang
Thomas
T
Karnik
Ronald
R
Ammerer
Hans Peter
HP
Ploder
Jürgen
J
Slany
Jörg
J
D018806:APACHE; D000368:Aged; D001317:Austria / Q000453:epidemiology; D015984:Causality; D003422:Critical Care / Q000592:standards*; D003953:Diagnosis-Related Groups / Q000706:statistics & numerical data*; D005260:Female; D015600:Glasgow Coma Scale; D006746:Hospital Bed Capacity, 500 and over; D017052:Hospital Mortality; D006801:Humans; D020300:Intracranial Hemorrhages / Q000175:diagnosis* / Q000401:mortality* / Q000628:therapy; D007427:Intracranial Pressure; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000592:standards*; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome