title: Mortality and long-term functional outcome associated with intracranial pressure after traumatic brain injury.
abstract: OBJECTIVE
  Elevated intracranial pressure (ICP) has been associated with increased mortality in patients with severe traumatic brain injury (TBI). We have examined whether raised ICP is independently associated with mortality, functional status and neuropsychological functioning in adult TBI patients.
  
  
  METHODS
  Data from a randomized trial of 499 participants were secondarily analyzed. The primary endpoints were mortality and a composite measure of functional status and neuropsychological function (memory, speed of information processing, executive function) over a 6-month period. The area under the curve of the ICP profile (average ICP) during the first 48 h of monitoring was the main predictor of interest. Multivariable regression was used to adjust for a priori defined confounders: age, Glasgow Coma Score, Abbreviated Injury Scale-head and hypoxia.
  
  
  RESULTS
  Of the participants, 365 patients had complete 48-h ICP data. The overall 6-month mortality was 18 %. The adjusted odds ratio of mortality comparing 10-mmHg increases in average ICP was 3.12 (95 % confidence interval 1.79, 5.44; p < 0.01). Overall, higher average ICP was associated with decreased functional status and neuropsychological functioning (p < 0.01). Importantly, among survivors, increasing average ICP was not independently associated with worse performance on neuropsychological testing (p = 0.46).
  
  
  CONCLUSIONS
  Average ICP in the first 48 h of monitoring was an independent predictor of mortality and of a composite endpoint of functional and neuropsychological outcome at the 6-month follow-up in moderate or severe TBI patients. However, there was no association between average ICP and neuropsychological functioning among survivors.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Harborview Anesthesiology Research Center, Harborview Medical Center, University of Washington School of Medicine, Seattle, WA 98104, USA.
authors.forename: Shide
authors.initials: S
authors.lastname: Badri
authors.forename: Jasper
authors.initials: J
authors.lastname: Chen
authors.forename: Jason
authors.initials: J
authors.lastname: Barber
authors.forename: Nancy R
authors.initials: NR
authors.lastname: Temkin
authors.forename: Sureyya S
authors.initials: SS
authors.lastname: Dikmen
authors.forename: Randall M
authors.initials: RM
authors.lastname: Chesnut
authors.forename: Steven
authors.initials: S
authors.lastname: Deem
authors.forename: N David
authors.initials: ND
authors.lastname: Yanez
authors.forename: Miriam M
authors.initials: MM
authors.lastname: Treggiari
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D001930:Brain Injuries / Q000175:diagnosis / Q000401:mortality* / Q000534:rehabilitation*; D003422:Critical Care; D005260:Female; D006801:Humans; D019586:Intracranial Hypertension / Q000453:epidemiology*; D008297:Male; D015999:Multivariate Analysis; D009483:Neuropsychological Tests; D011379:Prognosis; D011446:Prospective Studies; D020127:Recovery of Function; D014481:United States / Q000453:epidemiology