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Perceived Utility of Intracranial Pressure Monitoring in Traumatic Brain Injury: A Seattle International Brain Injury
Randall M Chesnut1,2,3,4, Sergio Aguilera5,6, Andras Buki7
1Department of Neurological Surgery, University of Washington, Seattle, Washington, USA.
Neurosurgery
|May 12, 2023
Summary
Intracranial pressure (ICP) monitoring is common, but guidelines are not always followed. Expert panel decisions show wider ICP monitor use than guidelines predict, emphasizing clinical examination. Heatmaps offer guidance for ICP monitor insertion decisions.
Area of Science:
- Neurosurgery
- Critical Care Medicine
- Neurology
Background:
- Intracranial pressure (ICP) monitoring is a common neurocritical care practice.
- Current indications for ICP monitoring are not fully established, and existing guidelines are often not followed.
- There is a need to understand current clinical decision-making for ICP monitoring.
Purpose of the Study:
- To examine the ICP monitoring practices of an expert panel from the Seattle International Brain Injury Consensus Conference.
- To assess the alignment between established ICP monitoring guidelines and expert clinical decision-making.
- To provide guidance for clinicians considering ICP monitor insertion.
Main Methods:
- 42 expert panel members evaluated virtual patients using clinical signs (Glasgow Coma Scale [GCS], pupillary response) and CT scans.
- Panelists made ICP monitor insertion decisions (yes, no, unsure) using a traffic light approach.
- Univariate regression analysis was used to determine the weighting of clinical signs in decision-making.
Main Results:
- ICP monitor use by the expert panel exceeded predictions based on current guidelines.
- Glasgow Coma Scale (GCS) scores were the most influential factor in ICP monitor decisions, applied non-linearly.
- The modified Marshall CT classification and pupillary examination were the second and third most important factors, respectively.
Conclusions:
- The perceived value of ICP monitoring in clinical practice extends beyond detecting severe intracranial hypertension.
- Developed heatmaps based on expert consensus can guide ICP monitor insertion decisions.
- Further research is needed to understand real-world ICP monitor insertion drivers.
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