The impact of intracranial pressure monitoring in severe traumatic brain injury: results from the National Trauma Registry.

Abstract

Objective: Intracranial pressure monitoring (ICPM) is a cornerstone procedure in the management of severe traumatic brain injury (TBI). Yet, its implementation is low and the impact on outcomes debated. The authors' objective was to determine the association between ICPM and 1-year mortality in severe TBI.

Methods: The authors performed a retrospective cohort study utilizing data from the Israel National Trauma Registry (INTR) of severe TBI patients admitted to level I trauma centers from 2015 to 2021. Multivariable logistic regressions were performed to calculate the odds ratio (OR) of 1-year mortality, adjusted for age, Glasgow Coma Scale (GCS) score, other severe injuries (nonhead Abbreviated Injury Scale [AIS] score ≥ 4), hypotension, and surgical decompression. The main outcome was 1-year mortality.

Results: Of 2202 patients, 36.8% underwent insertion of ICPM. ICPM patients had a lower 1-year mortality rate (28.12% vs 33.60%, p = 0.015). Compared with ICPM, the adjusted odds of 1-year mortality of no ICPM were increased 1.2-fold (OR 1.21, 95% CI 0.96-1.54). The effect size was greater among patients with head AIS score 5-6 and age 18-64 years (OR 1.57, 95% CI 1.13-2.20) and age ≥ 65 years (OR 1.92, 95% CI 1.04-3.55); the effect size of no ICPM in those with head AIS score 3-4 was decreased (OR 0.49, 95% CI 0.26-0.93).

Conclusions: A significant association between ICPM and lower 1-year mortality in the most severe TBI patients (head AIS score 5-6) who were ≥ 18 years of age was observed. The authors' study supports the use of ICPM in severe TBI. The authors recommend more detailed reporting to best inform quality improvement programs on a national scale. This research contributes to the academic dialogue on TBI and the considerations for enhancing patient care.