Introduction: It is well established that traumatic brain injury (TBI) is a process not limited to the injury sustained at the time of trauma. Hence, post-traumatic management of the trauma patient is critical, and may include placement of an intracranial pressure (ICP) monitor. Guidelines set by the Brain Trauma Foundation (BTF) (Fig. 1) outline the parameters for ICP monitor placement. The goal of this study is to determine if findings on head CT could positively predict the presence of increased ICP.
Methods: The institutional review board at Boston Medical Center (BMC) approved a retrospective study, reviewing all patients that had an ICP monitor placed for severe TBI over the past five years. Patient sex, age, GCS score and ICP were documented. The presence or absence of markers of increased intracranial pressure (midline shift, herniation, intracranial hemorrhage, sulcal effacement, cisternal effacement and/or hydrocephalus) was obtained from the admission head CT, which was read by a neuroradiologist. The Spearman correlation coefficient was used to test for significance.
Results: Our study included 43 patients, with an average GCS score of 5. Only 14 patients (32.6%) had increased ICP. The most common finding was sulcal effacement, which was present in 24 patients (55.8%), (Fig. 2). There was no statistically significant correlation (p >0.05) between ICP values and the number of findings (midline shift, hydrocephalus, cisternal effacement, sulcal effacement, hemorrhage or herniation. There was no significant correlation (p >0.05) between GCS before ICP monitor placement and either the ICP or the number of findings on the radiology report.
Conclusions: In our study, we did not find statistically significant correlation between ICP values and findings suggestive of intracranial hypertension on head CT. Future steps include a larger retrospective study or a prospective study to determine if ICP and head CT scan findings correlate.
Patient Care: Patient care may be improved by ensuring that invasive, costly intracranial pressure monitors are placed in appropriately indicated cases.
Learning Objectives: By the conclusion of this session, participants should be familiar with the current recommendations for placing intracranial pressure monitors. In addition, they should be able to identify potential markers of intracranial hypertension on head CT.
References: Bratton, Susan L., Randall M. Chestnut, Jamshid Ghajar, Flora F. Mcconnell Hammond, Odette A. Harris, Roger Hartl, Geoffrey T. Manley, Andrew Nemecek, David W. Newell, Guy Rosenthal, Joost Schouten, Lori Shutter, Shelly D. Timmons, Jamie S. Ullman, Walter Videtta, Jack E. Wilberger, and David W. Wright. "VI. Indications for Intracranial Pressure Monitoring." Journal of Neurotrauma 24.Supplement 1 (2007): S-37--44. Web.