The course of intracranial pressure in traumatic brain injury: relation with outcome and CT-characteristics.
BACKGROUND
One of the predictive factors of outcome in traumatic brain injury is high intracranial pressure (ICP). Recently, the time course of ICP has been described but few data are available on the relation of these ICP profiles and outcome. The aim of this study is to investigate the relation of the time course of ICP with CT-findings and outcome.


METHODS
Retrospective analysis of prospectively collected data of 246 patients with traumatic brain injury admitted to the neurosurgical intensive care unit.


RESULTS
Early rise in ICP (within the first 2 days) was present in 32%, an intermediate rise (between days 3 and 5) in 34% and a late rise (after day 5) in 34% of patients. Half of the patients with a normal opening pressure (76%) developed intermediate or late ICP rise profiles. More mass lesions and sub/epidural hematomas were present in the late rise group. Patients with a late ICP rise required significant more intensive treatment (65% vs. 37 and 33%) when compared to the early and intermediate rise groups. In multiple regression analysis both ICP profiles and extracranial hematomas were related to outcome. With late ICP rise more unfavorable outcome (46 vs. 17%, P < 0.001) was seen although one in four patients showed a favorable outcome.


CONCLUSIONS
During ICP monitoring different ICP profiles are present over time. These profiles are related to CT-characteristics and outcome. The importance of early and late monitoring of ICP is underlined.
Bremmer
Rosette
R
Department of Neurology, University and Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.
de Jong
Bauke M
BM
Wagemakers
Michiel
M
Regtien
Joost G
JG
van der Naalt
Joukje
J
D000328:Adult; D001930:Brain Injuries / Q000000981:diagnostic imaging* / Q000401:mortality / Q000503:physiopathology*; D003422:Critical Care; D004185:Disability Evaluation; D005260:Female; D015600:Glasgow Coma Scale; D023261:Glasgow Outcome Scale; D006407:Hematoma, Epidural, Cranial / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology; D006408:Hematoma, Subdural / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology; D006801:Humans; D007427:Intracranial Pressure / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D018458:Persistent Vegetative State / Q000503:physiopathology; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D055815:Young Adult