@article{ref1,
title="Perceived utility of intracranial pressure monitoring in traumatic brain injury: a Seattle international brain injury consensus conference consensus-based analysis and recommendations",
journal="Neurosurgery",
year="2023",
author="Chesnut, Randall M. and Aguilera, Sergio and Büki, Andras and Bulger, Eileen M. and Citerio, Giuseppe and Cooper, D. Jamie and Arrastia, Ramon Diaz and Diringer, Michael and Figaji, Anthony and Gao, Guoyi and Geocadin, Romergryko G. and Ghajar, Jamshid and Harris, Odette and Hawryluk, Gregory W. J. and Hoffer, Alan and Hutchinson, Peter and Joseph, Mathew and Kitagawa, Ryan and Manley, Geoffrey and Mayer, Stephan and Menon, David K. and Meyfroidt, Geert and Michael, Daniel B. and Oddo, Mauro and Okonkwo, David O. and Patel, Mayur B. and Robertson, Claudia and Rosenfeld, Jeffrey V. and Rubiano, Andrés M. and Sahuquillo, Juain and Servadei, Franco and Shutter, Lori and Stein, Deborah M. and Stocchetti, Nino and Taccone, Fabio Silvio and Timmons, Shelly D. and Tsai, Eve C. and Ullman, Jamie S. and Videtta, Walter and Wright, David W. and Zammit, Christopher",
volume="ePub",
number="ePub",
pages="ePub-ePub",
abstract="BACKGROUND: Intracranial pressure (ICP) monitoring is widely practiced, but the indications are incompletely developed, and guidelines are poorly followed. <br><br>OBJECTIVE: To study the monitoring practices of an established expert panel (the clinical working group from the Seattle International Brain Injury Consensus Conference effort) to examine the match between monitoring guidelines and their clinical decision-making and offer guidance for clinicians considering monitor insertion. <br><br>METHODS: We polled the 42 Seattle International Brain Injury Consensus Conference panel members' ICP monitoring decisions for virtual patients, using matrices of presenting signs (Glasgow Coma Scale [GCS] total or GCS motor, pupillary examination, and computed tomography diagnosis). Monitor insertion decisions were yes, no, or unsure (traffic light approach). We analyzed their responses for weighting of the presenting signs in decision-making using univariate regression. <br><br>RESULTS: Heatmaps constructed from the choices of 41 panel members revealed wider ICP monitor use than predicted by guidelines. Clinical examination (GCS) was by far the most important characteristic and differed from guidelines in being nonlinear. The modified Marshall computed tomography classification was second and pupils third. We constructed a heatmap and listed the main clinical determinants representing 80% ICP monitor insertion consensus for our recommendations. <br><br>CONCLUSION: Candidacy for ICP monitoring exceeds published indicators for monitor insertion, suggesting the clinical perception that the value of ICP data is greater than simply detecting and monitoring severe intracranial hypertension. Monitor insertion heatmaps are offered as potential guidance for ICP monitor insertion and to stimulate research into what actually drives monitor insertion in unconstrained, real-world conditions.<p /> <p>Language: en</p>",
language="en",
issn="0148-396X",
doi="10.1227/neu.0000000000002516",
url="http://dx.doi.org/10.1227/neu.0000000000002516"
}