title: A Propensity Score Analysis of the Impact of Invasive Intracranial Pressure Monitoring on Outcomes after Severe Traumatic Brain Injury.
abstract: Although a recent clinical trial (BEST TRIP) demonstrated no improvement in outcomes with invasive intracranial pressure (ICP) monitoring (ICPM) following severe traumatic brain injury (TBI), its generalizability has been called into question. In several global settings ICPM is not the standard of care and is used at the discretion of the attending neurosurgeon. Our objective was to determine the impact of ICPM on mortality and 6-month functional outcomes following severe TBI. The setting was a referral trauma center with 36 intensive care unit (ICU) beds and 300-600 TBI admissions per year. During a 2-year period data were prospectively entered into a severe TBI registry. Patients with severe TBI aged >12 years meeting Brain Trauma Foundation (BTF) criteria for ICPM were included in the study. Outcomes of interest were in-hospital mortality and poor 6-month functional outcome defined as Glasgow Outcome Scale (GOS) score of 3 or lower. A propensity score based analysis incorporating known predictors of outcome in TBI was utilized to examine the impact of ICPM on outcomes. Of 1345 patients meeting study criteria 497 (37%) underwent ICPM. In-hospital mortality was 35% (471/1345). Of 454 patients for whom 6-month outcome was available, 161 (35%) suffered a poor functional outcome. Following propensity score analysis ICPM use was associated with an 8% (p = 0.002) decrease in mortality but no significant effect (p = 0.2) on functional outcome. The use of ICPM following severe TBI was associated with decreased in-hospital mortality. Further clinical trials of ICPM in TBI may be warranted.
authors.affiliation: 1 JPN Apex Trauma Center and Neurosciences Center , Ansari Nagar, India .
authors.forename: Deepak
authors.initials: D
authors.lastname: Agrawal
authors.affiliation: 2 Department of Surgery, University of Michigan , Ann Arbor, Michigan.
authors.forename: Krishnan
authors.initials: K
authors.lastname: Raghavendran
authors.affiliation: 3 Department of Biostatistics, University of Michigan , Ann Arbor, Michigan.
authors.forename: Douglas E
authors.initials: DE
authors.lastname: Schaubel
authors.affiliation: 4 Department of Surgical Disciplines All India Institute of Medical Sciences , Ansari Nagar, India .
authors.forename: Mahesh C
authors.initials: MC
authors.lastname: Mishra
authors.affiliation: 5 Departments of Neurosurgery and Neurology, University of Michigan , Ann Arbor, Michigan.
authors.forename: Venkatakrishna
authors.initials: V
authors.lastname: Rajajee
mesh_terms: D000328:Adult; D000070642:Brain Injuries, Traumatic / Q000175:diagnosis* / Q000401:mortality* / Q000503:physiopathology; D005260:Female; D023261:Glasgow Outcome Scale / Q000639:trends*; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007427:Intracranial Pressure / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods / Q000639:trends; D057216:Propensity Score; D011446:Prospective Studies; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome
keywords: Glasgow Outcome Scale; developing countries; intracranial pressure; traumatic brain injury