title: Intraventricular intracranial pressure monitoring improves the outcome of older adults with severe traumatic brain injury: an observational, prospective study.
abstract: Intracranial pressure (ICP) monitoring is widely used in the management of patients with severe traumatic brain injury (TBI). However, there is limited evidence about the efficacy of ICP monitoring in older subjects (aged ≥65 years). This study evaluated the effect of intraventricular ICP monitoring on the outcome of older adults suffering from a severe TBI.
  
  
  
  This prospective, observational study included 166 older TBI patients (aged ≥65 years) with Glasgow Coma scale (GCS) scores lower than 9 at admission. The study cohort was divided into two groups, intraventricular ICP monitoring and non-ICP monitoring. The primary outcome was in-hospital mortality. The secondary outcomes included the Glasgow Outcome Scale (GOS) score 6 months after injury, the ICU and total hospital lengths of stay, and mechanical ventilation days.
  
  
  
  There were 80 patients in the intraventricular ICP monitoring group and 86 patients in non-ICP monitoring group. There was no statistical difference between groups in demographics and severity of head injury. Patients treated with intraventricular ICP monitoring had lower in-hospital mortality (33.8 % vs 51.2 %, P < 0.05), a higher 6-month GOS score (3.0 ± 1.4 vs 2.5 ± 1.2 P < 0.05), and a lower dosage (514 ± 246 g vs 840 ± 323 g, P < 0.0001) and shorter duration (7.2 ± 3.6 days vs 8.4 ± 4.3 days, P < 0.01) of mannitol use. However, the ICU length of stay (14.3 ± 6.4 days vs 11.6 ± 5.8 days, P < 0.01) and mechanical ventilation days (6.7 ± 3.5 days vs 5.6 ± 2.4 days, P < 0.05) were longer in the ICP monitoring group. The total length of hospital stay did not differ between the two groups (28.5 ± 12.1 days vs 26.1 ± 13.5 days, P = 0.23).
  
  
  
  Intraventricular ICP monitoring may have beneficial effects on the decreased in-hospital mortality and improved 6-month outcome of older patients with severe TBI. However, given that this was an observational study conducted in a single institution, further well-designed randomized control trials are needed to evaluate the effect of intraventricular ICP monitoring on the outcome of older severe TBI patients.
authors.affiliation: Department of Neurosurgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, People's Republic of China.|Shanghai Institute of Head Trauma, Shanghai, 200127, People's Republic of China.
authors.forename: Wendong
authors.initials: W
authors.lastname: You
authors.affiliation: Department of Neurosurgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, People's Republic of China.|Shanghai Institute of Head Trauma, Shanghai, 200127, People's Republic of China.
authors.forename: Junfeng
authors.initials: J
authors.lastname: Feng
authors.affiliation: Department of Neurosurgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, People's Republic of China.|Shanghai Institute of Head Trauma, Shanghai, 200127, People's Republic of China.
authors.forename: Qilin
authors.initials: Q
authors.lastname: Tang
authors.affiliation: Department of Neurosurgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, People's Republic of China.|Shanghai Institute of Head Trauma, Shanghai, 200127, People's Republic of China.
authors.forename: Jun
authors.initials: J
authors.lastname: Cao
authors.affiliation: Department of Neurosurgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, People's Republic of China.|Shanghai Institute of Head Trauma, Shanghai, 200127, People's Republic of China.
authors.forename: Lei
authors.initials: L
authors.lastname: Wang
authors.affiliation: Department of Neurosurgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, People's Republic of China.|Shanghai Institute of Head Trauma, Shanghai, 200127, People's Republic of China.
authors.forename: Jin
authors.initials: J
authors.lastname: Lei
authors.affiliation: Department of Neurosurgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, People's Republic of China.|Shanghai Institute of Head Trauma, Shanghai, 200127, People's Republic of China.
authors.forename: Qing
authors.initials: Q
authors.lastname: Mao
authors.affiliation: Department of Neurosurgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, People's Republic of China. gao3@sina.com.|Shanghai Institute of Head Trauma, Shanghai, 200127, People's Republic of China. gao3@sina.com.
authors.forename: Guoyi
authors.initials: G
authors.lastname: Gao
authors.affiliation: Department of Neurosurgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, People's Republic of China.|Shanghai Institute of Head Trauma, Shanghai, 200127, People's Republic of China.
authors.forename: Jiyao
authors.initials: J
authors.lastname: Jiang
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000070642:Brain Injuries, Traumatic / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D015600:Glasgow Coma Scale; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D007427:Intracranial Pressure; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008353:Mannitol / Q000008:administration & dosage; D008991:Monitoring, Physiologic / Q000379:methods*; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000706:statistics & numerical data*
chemical_list: D008353:Mannitol
keywords: Intraventricular intracranial pressure monitoring; Older adults; Severe traumatic brain injury