Citation

Hoffman H, Bunch KM, Furst T, Chin LS. World Neurosurg. 2020; ePub(ePub): ePub.

Copyright

(Copyright © 2020, Elsevier Publishing)

DOI

10.1016/j.wneu.2020.07.022

PMID

32668331

Abstract

OBJECTIVE: The Brain Trauma Foundation (BTF) recommends intracranial pressure (ICP) monitoring for all salvageable patients with an abnormal CT scan and a Glasgow Coma Scale less than 9. Studies have demonstrated that compliance with this is low. We sought to obtain contemporary national rates of ICP monitor placement in patients with severe TBI.

METHODS: Patients from the National Trauma Data Bank from 2013 to 2017 who met BTF criteria for ICP monitoring were included. Placement of an intraparenchymal ICP monitor or an external ventricular drain was queried. Binary logistic regression was used to determine factors that influenced the placement of an ICP monitor.

RESULTS: There were 21,374 patients with severe TBI and an abnormal CT scan included in the study. An ICP monitor was placed in 6,543 patients (30.6%). ICP monitor placement increased modestly from 28.6% in 2013 to 32.8% in 2017. The pooled odds of ICP monitor placement between 2014 and 2017 were not different from 2013 (OR 1.04, 95% CI 0.99 - 1.09), but the adjusted odds of ICP monitor placement in 2017 were significantly greater (OR 1.18, 95% CI 1.06 - 1.30). Treatment at a teaching hospital, subdural hematoma, multiple intracranial abnormalities on CT, and greater injury severity score were associated with ICP monitor placement, while older age was negatively associated with ICP monitor placement.

CONCLUSION: The rate of ICP monitoring in patients with severe TBI who meet BTF criteria is low and only increased slightly from 2013 to 2017.

Language: en

Keywords

guidelines; intracranial pressure monitoring; Severe traumatic brain injury