title: The effects of intracranial pressure monitoring in patients with traumatic brain injury.
abstract: BACKGROUND
  Although international guideline recommended routine intracranial pressure (ICP) monitoring for patients with severe traumatic brain injury(TBI), there were conflicting outcomes attributable to ICP monitoring according to the published studies. Hence, we conducted a meta-analysis to evaluate the efficacy and safety of ICP monitoring in patients with TBI.
  
  
  METHODS
  Based on previous reviews, PubMed and two Chinese databases (Wangfang and VIP) were further searched to identify eligible studies. The primary outcome was mortality. Secondary outcomes included unfavourable outcome, adverse events, length of ICU stay and length of hospital stay. Weighted mean difference (WMD), odds ratio (OR) and 95% confidence intervals (CIs) were calculated and pooled using fixed-effects or random-effects model.
  
  
  RESULTS
  two randomized controlled trials (RCTs) and seven cohort studies involving 11,038 patients met the inclusion criteria. ICP monitoring was not associated with a significant reduction in mortality (OR, 1.16; 95% CI, 0.87-1.54), with substantial heterogeneity (I(2) = 80%, P<0.00001), which was verified by the sensitivity analyses. No significant difference was found in the occurrence of unfavourable outcome (OR, 1.40; 95% CI, 0.99-1.98; I(2) = 4%, P = 0.35) and adverse events (OR, 1.04; 95% CI, 0.64-1.70; I(2) = 78%, P = 0.03). However, we should be cautious to the result of adverse events because of the substantial heterogeneity in the comparison. Furthermore, longer ICU and hospital stay were the consistent tendency according to the pooled studies.
  
  
  CONCLUSIONS
  No benefit was found in patients with TBI who underwent ICP monitoring. Considering substantial clinical heterogeneity, further large sample size RCTs are needed to confirm the current findings.
authors.affiliation: The Department of Neurosurgery, Tongji Hospital, Tongji University School of Medicine, Shanghai, China.
authors.forename: Shao-Hua
authors.initials: SH
authors.lastname: Su
authors.affiliation: The Department of Neurosurgery, Tongji Hospital, Tongji University School of Medicine, Shanghai, China.
authors.forename: Fei
authors.initials: F
authors.lastname: Wang
authors.affiliation: The Department of Neurosurgery, Tongji Hospital, Tongji University School of Medicine, Shanghai, China.
authors.forename: Jian
authors.initials: J
authors.lastname: Hai
authors.affiliation: The Department of Neurosurgery, Tongji Hospital, Tongji University School of Medicine, Shanghai, China.
authors.forename: Ning-Tao
authors.initials: NT
authors.lastname: Liu
authors.affiliation: The Department of Neurosurgery, Tongji Hospital, Tongji University School of Medicine, Shanghai, China.
authors.forename: Fei
authors.initials: F
authors.lastname: Yu
authors.affiliation: The Department of Neurosurgery, Tongji Hospital, Tongji University School of Medicine, Shanghai, China.
authors.forename: Yi-Fang
authors.initials: YF
authors.lastname: Wu
authors.affiliation: The Department of Neurosurgery, Tongji Hospital, Tongji University School of Medicine, Shanghai, China.
authors.forename: You-Hou
authors.initials: YH
authors.lastname: Zhu
mesh_terms: D001930:Brain Injuries / Q000473:pathology*; D006801:Humans; D007427:Intracranial Pressure / Q000502:physiology*; D007902:Length of Stay / Q000706:statistics & numerical data; D015233:Models, Statistical; D008991:Monitoring, Physiologic / Q000009:adverse effects* / Q000379:methods* / Q000401:mortality*; D016017:Odds Ratio