title: Intracranial pressure monitoring in severe head injury: compliance with Brain Trauma Foundation guidelines and effect on outcomes: a prospective study.
abstract: OBJECTIVE
  The Brain Trauma Foundation (BTF) has established guidelines for intracranial pressure (ICP) monitoring in severe traumatic brain injury (TBI). This study assessed compliance with these guidelines and the effect on outcomes.
  
  
  METHODS
  This is a prospective, observational study including patients with severe blunt TBI (Glasgow Coma Scale score ≤ 8, head Abbreviated Injury Scale score ≥ 3) between January 2010 and December 2011. Demographics, clinical characteristics, laboratory profile, head CT scans, injury severity indices, and interventions were collected. The study population was stratified into 2 study groups: ICP monitoring and no ICP monitoring. Primary outcomes included compliance with BTF guidelines, overall in-hospital mortality, and mortality due to brain herniation. Secondary outcomes were ICU and hospital lengths of stay. Multiple regression analyses were deployed to determine the effect of ICP monitoring on outcomes.
  
  
  RESULTS
  A total of 216 patients met the BTF guideline criteria for ICP monitoring. Compliance with BTF guidelines was 46.8% (101 patients). Patients with subarachnoid hemorrhage and those who underwent craniectomy/craniotomy were significantly more likely to undergo ICP monitoring. Hypotension, coagulopathy, and increasing age were negatively associated with the placement of ICP monitoring devices. The overall in-hospital mortality was significantly higher in patients who did not undergo ICP monitoring (53.9% vs 32.7%, adjusted p = 0.019). Similarly, mortality due to brain herniation was significantly higher for the group not undergoing ICP monitoring (21.7% vs 12.9%, adjusted p = 0.046). The ICU and hospital lengths of stay were significantly longer in patients subjected to ICP monitoring.
  
  
  CONCLUSIONS
  Compliance with BTF ICP monitoring guidelines in our study sample was 46.8%. Patients managed according to the BTF ICP guidelines experienced significantly improved survival.
authors: Division of Acute Care Surgery (Trauma, Emergency Surgery and Surgical Critical Care), Department of Surgery, Keck School of Medicine, Los Angeles County + University of Southern California Medical Center, Los Angeles, California.
authors: Peep
authors: P
authors: Talving
authors: Efstathios
authors: E
authors: Karamanos
authors: Pedro G
authors: PG
authors: Teixeira
authors: Dimitra
authors: D
authors: Skiada
authors: Lydia
authors: L
authors: Lam
authors: Howard
authors: H
authors: Belzberg
authors: Kenji
authors: K
authors: Inaba
authors: Demetrios
authors: D
authors: Demetriades
mesh_terms: D000328:Adult; D000367:Age Factors; D001921:Brain / Q000098:blood supply* / Q000473:pathology / Q000503:physiopathology; D001930:Brain Injuries / Q000175:diagnosis / Q000401:mortality* / Q000503:physiopathology; D005260:Female; D006547:Hernia / Q000209:etiology / Q000401:mortality; D006801:Humans; D007427:Intracranial Pressure / Q000502:physiology*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000592:standards*; D063868:Patient Outcome Assessment; D011446:Prospective Studies; D013345:Subarachnoid Hemorrhage / Q000209:etiology / Q000401:mortality; D015599:Trauma Severity Indices