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Is Intracranial Pressure Monitoring After Open Cranial Procedures Associated With Outcome?
Peter Aziz1, Alison Muller2, Christopher Butts2
1Drexel University College of Medicine at Tower Health, Wyomissing, Pennsylvania.
Insights
Early intracranial pressure monitoring (ICPM) after open cranial procedures (OC) for traumatic brain injury was associated with increased mortality. Further investigation into ICPM indications after OC is warranted.
Area of Science:
- Neurosurgery
- Trauma Surgery
- Critical Care Medicine
Background:
- Intracranial pressure monitoring (ICPM) is crucial in managing severe traumatic brain injury (TBI).
- The impact of early ICPM following open cranial procedures (OC) on mortality remains unclear.
- This study investigates the association between ICPM timing and outcomes after OC in TBI patients.
Purpose of the Study:
- To determine if early ICPM after OC for TBI is associated with lower mortality.
- To compare outcomes between patients receiving ICPM within 72 hours versus those with no or delayed ICPM.
Main Methods:
- Utilized 2020-2021 data from the American College of Surgeons Trauma Quality Improvement Program.
- Included patients aged ≥16 years undergoing OC at level 1 and 2 trauma centers.
- Employed logistic regression to analyze in-hospital mortality based on ICPM timing (early vs. none/delayed).
Main Results:
- A total of 19,830 patients were analyzed; 29% received early ICPM.
- Early ICPM patients had more severe injuries and higher baseline mortality risk.
- Early ICPM was significantly associated with increased in-hospital mortality (OR 1.35, 95% CI 1.24-1.47), even in isolated brain injury cases.
Conclusions:
- Placing ICPM within 72 hours of OC for TBI was linked to higher mortality.
- Current indications for ICPM after OC require further examination.
- Multicenter prospective studies are needed to clarify ICPM's role and optimize its use in TBI management.
Introduction:
It is unclear if intracranial pressure monitoring (ICPM) after open cranial procedures (craniotomy or craniectomy) (OC) for traumatic brain injury is associated with mortality. We hypothesized that ICPM placed early after OC was associated with lower mortality compared to no ICPM or delayed ICPM placement.
Methods:
Using 2020-2021 data from the American College of Surgeons Trauma Quality Improvement Program, patients ≥16 y from level 1 and 2 trauma centers who underwent OC were divided into two groups: ICPM placed within 72 h of OC (early) and no ICPM or ICPM placed after 72 h (none/delayed). Outcome was in-hospital mortality. Logistic regression was used to elucidate predictors of mortality.
Results:
A total of 19,830 patients (early ICPM, 29%) were included. Early patients were more likely to be from level 1 centers (63% versus 60%, P = 0.004), younger (median age 47 versus 60, P < 0.0001), to have a lower Glasgow Coma Score (median, 6 versus 14, P < 0.0001), higher injury severity score (median, 26 versus 26, P < 0.0001), an unreactive pupil (33% versus 18%, P < 0.0001), midline shift >5 mm (69% versus 60%, P < 0.0001), received ≥2 units of blood/first 4 h (14% versus 6%, P < 0.0001) and higher mortality (31% versus 19%, P < 0.0001) compared to none/delayed patients. Controlled for significant variables, early ICPM was associated with increased mortality (odds ratio 1.35, 95% confidence interval 1.24-1.47). Analysis of subjects with isolated brain injury found a similar association (odds ratio 1.32, 95% C1 1.15-1.52).
Conclusions:
ICPM placed within 72 h of OC was associated with increased mortality. Indications for ICPM after OC should be investigated further in multicenter prospective studies.
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