Introduction: There have been several new advances in the treatment of traumatic brain injury (TBI) in recent years, including the use of intracranial multimodality monitoring. Among these, ICP monitoring, maintaining CPP, monitoring PbtO2 and NIRS have been incorporated to target therapy. Currently, the use of the Predicting Outcome After Traumatic Brain Injury score (CRASH) has been used to obtain predictions of relevant outcomes in patients with TBI. The goal of this study is determine if the use of intracranial multimodality monitoring within TBI patients will reduce their predicted mortality.
Methods: A retrospective analysis of 35 patients with severe TBI that received intracranial multimodality monitoring from 2011-2012 were included in this study. Analysis of the charts were performed to determine the patients age, Glasgow coma scale, pupil reactivity, and the presence of major extracranial injury. The official report of the patient’s computed tomography (CT) scans were also reviewed to determine the presence of petechial hemorrhages, obliteration of the third ventricle or basal cisterns, subarachnoid bleeding, midline shift and the presence of a non-evacuated hematoma.
Results: Using the CRASH predictive model, the 14-day predicted mortality was 55% (ranging from 8% to 98%). With aggressive, goal directed therapy, the 14-day mortality at our institution was reduced to 31%. In a subgroup analysis including only patients with a predicted mortality of 75% or greater (n = 10), our predicted mortality was 93%. Multimodality therapy reduced mortality to 60%. In patients with a predicted mortality of 50% or greater (n = 19), predicted mortality and actual mortality were 79% and 58%, respectively.
Conclusions: Although there continues to be no consensus regarding the use of intracranial multimodality monitoring in TBI patients, our patients demonstrated a clear benefit in the reduction of 14-day mortality risk when applying the CRASH predictive model.
Patient Care: Intracranial multimodality monitoring in TBI patients, along with strong neurocritical care practices, allows for a reduction in predicted mortality.
Learning Objectives: By the end of this session, participants will understand that the advances provided by intracranial multimodality monitoring, along with strong neurocritical care practices allows for a reduction in predicted mortality.