title: Intraparenchymal vs extracranial ventricular drain intracranial pressure monitors in traumatic brain injury: less is more?
abstract: BACKGROUND
  Management of severe traumatic brain injury has centered on continuous intracranial pressure (ICP) monitoring with intraparenchymal ICP monitors (IPM) or extracranial ventricular drains (EVD). Our hypothesis was that neurologic outcomes are unaffected by the type of ICP monitoring device.
  
  
  METHODS
  We reviewed 377 adult patients with traumatic brain injury requiring ICP monitoring. Primary outcome was Glasgow Outcome Score (GOS) 1 month after injury. Secondary outcomes included mortality, monitoring-related complications, and length of ICU and hospital stay.
  
  
  RESULTS
  There were 253 patients managed with an IPM and 124 with an EVD. There was no difference in Glasgow Outcome Score (2.7 ± 1.3 vs 2.5 ± 1.3, p = 0.45), mortality (30.9% vs 32.2%, p = 0.82), and hospital length of stay (LOS) (15.6 ± 12.4 days vs 16.4 ± 10.7 days, p = 0.57). Device-related complications (11.9% vs 31.1%, p < 0.001), duration of ICP monitoring (3.8 ± 2.6 days vs 7.3 ± 5.6 days, p < 0.001), and ICU LOS (7.6 ± 5.6 days vs 9.5 ± 6.2 days, p = 0.004) were longer in the EVD group. Age, opening ICP, and size of midline shift were independent predictors for neurologic outcomes and mortality, when type and severity of brain injury, as well as overall injury severity were controlled for. Duration of ICP monitoring and opening ICP were independent predictors for hospital LOS and the former predicted prolonged ICU stay. Device-related complications were affected by type of device.
  
  
  CONCLUSIONS
  Use of EVDs in adult traumatic brain injury patients is associated with prolonged ICP monitoring, ICU LOS, and more frequent device-related complications.
authors.affiliation: Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
authors.forename: George
authors.initials: G
authors.lastname: Kasotakis
authors.forename: Maria
authors.initials: M
authors.lastname: Michailidou
authors.forename: Athanosios
authors.initials: A
authors.lastname: Bramos
authors.forename: Yuchiao
authors.initials: Y
authors.lastname: Chang
authors.forename: George
authors.initials: G
authors.lastname: Velmahos
authors.forename: Hasan
authors.initials: H
authors.lastname: Alam
authors.forename: David
authors.initials: D
authors.lastname: King
authors.forename: Marc A
authors.initials: MA
authors.lastname: de Moya
mesh_terms: D001930:Brain Injuries / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D015600:Glasgow Coma Scale; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007362:Intensive Care Units; D007427:Intracranial Pressure; D007902:Length of Stay / Q000639:trends; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000295:instrumentation*; D011446:Prospective Studies; D015203:Reproducibility of Results; D015996:Survival Rate / Q000639:trends; D015599:Trauma Severity Indices; D014481:United States / Q000453:epidemiology