Intracranial pressure dose and outcome in traumatic brain injury.
OBJECTIVE
Detecting and treating elevated intracranial pressure (ICP) is a cornerstone of management in patients with severe traumatic brain injury. The aim of this study was to determine the association between area under the curve measurement of elevated ICP and clinical outcome.


METHODS
Single center observational study using prospectively collected data at a University hospital, level one-trauma center. Sixty prospective patients with severe traumatic brain injury were prospectively enrolled over a 2-year period. Intracranial pressure measurements were captured using a real-time automated, high resolution vital signs data recording system. Mortality and functional outcome were assessed at 30 days, 3 and 6 months using Extended Glasgow Outcome Scale.


RESULTS
Increasing elevated intracranial pressure time dose was associated with mortality (OR 1.08; 95 % confidence interval [CI], 1.01-1.15, p = 0.03) and poor functional outcome at 3 (OR 1.04; CI 1.00-1.07, p = 0.03) and 6 months (1.04; CI 1.01-1.08, p = 0.02). However, there was no association between episodic ICP data and outcome.


CONCLUSIONS
These results suggest that pressure time dose measurement of intracranial pressure may be used to predict outcome in severe traumatic brain injury and may be a candidate biomarker in this disease.
Department of Neurology, University of Maryland School of Medicine, Baltimore, MD 21201, USA. ksheth@som.umaryland.edu
Kevin N
KN
Sheth
Deborah M
DM
Stein
Bizhan
B
Aarabi
Peter
P
Hu
Joseph A
JA
Kufera
Thomas M
TM
Scalea
Daniel F
DF
Hanley
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D001930:Brain Injuries / Q000150:complications / Q000401:mortality* / Q000628:therapy; D005260:Female; D023261:Glasgow Outcome Scale; D006801:Humans; D019586:Intracranial Hypertension / Q000150:complications / Q000401:mortality* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome; D055815:Young Adult