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Intracranial Pressure Monitoring in Patients With Severe Traumatic Brain Injury: Extension of the Recommendations and the Effect on Outcome by Propensity Score Matching

医学 格拉斯哥昏迷指数 倾向得分匹配 创伤性脑损伤 颅内压 格拉斯哥结局量表 第七节 颅内压监测 优势比 内科学 外科 精神科
作者
Ana M. Castaño-Leon,Pedro A. Gomez,Luís Jimenez-Roldan,Igor Paredes,Pablo M. Munarriz,Irene Panero Perez,Carla Eiriz Fernandez,Daniel García-Pérez,Luis Miguel Moreno Gomez,Olga Esteban Sinovas,Guillermo Garcia Posadas,Alfonso Lagares
出处
期刊:Neurosurgery [Lippincott Williams & Wilkins]
卷期号:91 (3): 437-449
标识
DOI:10.1227/neu.0000000000002044
摘要

Intracranial pressure (ICP) monitoring is recommended for patients with traumatic brain injury (TBI) with a Glasgow Coma Scale (GCS) <9 on admission and revealing space-occupying lesions or swelling on computed tomography. However, previous studies that have evaluated its effect on outcome have shown conflicting results.To study the effect of ICP monitoring on outcome after adjustment of patient's characteristics imbalance and determine the potential benefit on patients with higher GCS that deteriorates early or in the absence of computed tomography results suggesting high ICP.We searched for adult patients with TBI admitted between 1996 and 2020 with a GCS <9 on admission or deterioration from higher scores within 24 hours after TBI. Patients were divided into groups if they fulfilled strict (Brain Trauma Foundation guidelines) or extended criteria (patients who worsened after admission or without space-occupying lesions) for ICP monitoring. Propensity score analyses based on nearest neighbor matching was performed.After matching, we analyzed data from 454 patients and 184 patients who fulfilled strict criteria or extended criteria for ICP monitoring, respectively. A decreased on in-hospital mortality was detected in monitored patients following strict and extended criteria . Those patients with a higher baseline risk of poor outcome showed higher odds of favorable outcome if they were monitored.ICP monitoring in patients with severe TBI within 24 hours after injury following strict and extended criteria was associated with a decreased in-hospital mortality. The identification of patients with a higher risk of an unfavorable outcome might be useful to better select cases that would benefit more from ICP monitoring.

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