Introduction: It became increasingly necessary to rethink the value and clinical implication of TBI management guided by ICP monitoring.
Methods: A retrospective observational multicenter study was conducted. Data was collected on adult moderate or severe TBI patients treated from January 2012 to December 2013 in 22 hospitals (16 level I trauma centers and 6 level II trauma centers) of nine Chinese provinces. All data were collected by physicians from medical records. The 6-month mortality and favorable outcome were assessed with the Glasgow Outcome Scale Extended score.
Results: An intracranial pressure monitor was inserted into 838 patients (58.1%). The significant predictors of intracranial pressure monitoring included the mechanism of injury, a Glasgow Coma Scale score of 9–12 at admission that dropped to a score of 3–8 within 24 hours after injury, a Marshall CT classification of III–IV, the presence of a major extracranial injury, subdural hematoma, intraparenchymal lesions, trauma center level, and intracranial pressure monitoring utilization of hospital. Multivariate logistic regression analyses showed that intracranial pressure monitoring resulted in a significantly lower 6-month mortality for patients who had a Glasgow Coma Scale score of 3–5 at admission (adjusted odds ratio, 0.57; 95% CI, 0.36–0.90), those who had a Glasgow Coma Scale score of 9–12 at admission that dropped to 3–8 within 24 hours after injury (adjusted odds ratio, 0.28; 95% CI, 0.08–0.96), and those who had a probability of death at 6 months greater than 0.6 (adjusted odds ratio, 0.55; 95% CI, 0.32–0.94).
Conclusions: There were multiple differences between the intracranial pressure monitoring and no intracranial pressure monitoring groups regarding patient characteristics, injury severity, characteristics of CT scan, and hospital type. Intracranial pressure monitoring in conjunction with intracranial pressure–targeted therapies is significantly associated with lower mortality in some special traumatic brain injury subgroups.
Patient Care: These results were further analyzed based on a classification of the various TBI pathophysiologies using the clinical features and CT scans of the patients to explore the specific subgroups for which ICP monitoring might be significantly associated with improved outcomes.
Learning Objectives: To evaluate the efficacy of traumatic brain injury management guided by intracranial pressure monitoring and to explore the specific subgroups for which intracranial pressure monitoring might be significantly associated with improved outcomes based on a classification of the various traumatic brain injury pathophysiologies using the clinical features and CT scans.