title: Role of Intracranial Pressure Monitoring in Management of Patients with Severe Traumatic Brain Injury: Results of a Large Level I Trauma Center in Southern Iran.
abstract: OBJECTIVE
  To determine the role of intracranial pressure (ICP) monitoring in management of patients with severe traumatic brain injury (TBI) admitted to a large level I trauma center in Southern Iran.
  
  
  METHODS
  This was a cohort study performed during a 2-year period in a level I trauma center in Southern Iran including all adult patients (>16 years) with severe TBI (Glasgow Coma Scale [GCS] score, 3-8) who underwent ICP monitoring through ventriculostomy. The management was based on the recorded ICP values with threshold of 20 mm Hg. Decompressive craniectomy was performed in patients with intractable intracranial hypertension (persistent ICP ≥25 mm Hg). In unresponsive patients, barbiturate coma was induced. Patients were followed for 6 months and Glasgow Outcome Scale Extended was recorded. The determinants of favorable and unfavorable outcome were also determined.
  
  
  RESULTS
  Overall, we included 248 patients with mean age of 34.6 ± 16.6 years, among whom there were 216 men (87.1%) and 32 women (12.9%). Eighty-five patients (34.2%) had favorable and 163 (65.8%) unfavorable outcomes. Those with favorable outcome had significantly lower age (P = 0.004), higher GCS score on admission (P < 0.001), lower Rotterdam score (P = 0.035), fewer episodes of intracranial hypertension (P < 0.001), and lower maximum recorded ICP (P = 0.041). These factors remained statistically significant after elimination of confounders by multivariate logistic regression model.
  
  
  CONCLUSIONS
  Age, GCS score on admission, Rotterdam score, intracranial hypertension, and maximum recorded ICP are important determinants of outcome in patients with severe TBI. ICP monitoring assisted us in targeted therapy and management of patients with severe TBI.
authors.affiliation: Trauma Research Center, Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Hosseinali
authors.initials: H
authors.lastname: Khalili
authors.affiliation: Neuroscience Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Nazanin
authors.initials: N
authors.lastname: Sadraei
authors.affiliation: Student Research Committee, Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Amin
authors.initials: A
authors.lastname: Niakan
authors.affiliation: Student Research Committee, Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran. Electronic address: fariborz.ghaffarpasand@gmail.com.
authors.forename: Fariborz
authors.initials: F
authors.lastname: Ghaffarpasand
authors.affiliation: Neuroscience Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Amin
authors.initials: A
authors.lastname: Sadraei
mesh_terms: D000058:Accidental Falls; D000063:Accidents, Traffic; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000070642:Brain Injuries, Traumatic / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D002560:Cerebrovascular Circulation; D015331:Cohort Studies; D056424:Decompressive Craniectomy; D019468:Disease Management; D005260:Female; D015600:Glasgow Coma Scale; D023261:Glasgow Outcome Scale; D006801:Humans; D015601:Injury Severity Score; D019586:Intracranial Hypertension / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D007427:Intracranial Pressure; D007492:Iran; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D015999:Multivariate Analysis; D011379:Prognosis; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed; D014193:Trauma Centers; D014696:Ventriculostomy; D014754:Violence; D055815:Young Adult
keywords: Cerebral perfusion pressure; Intracranial pressure monitoring; Prognosis; Traumatic brain injury; Ventriculostomy