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  • Treatment Strategy for Brain Contusion in Patients with Traumatic Brain Injury—First ICP Monitoring or First Operation: A Large Cohort Study

    Final Number:
    191

    Authors:
    qiang yuan

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2018 Annual Meeting

    Introduction: Previous surgical guidelines for brain contusions are based primarily on imaging and clinical features due to the lower use of intracranial pressure (ICP) monitoring. Whether ICP-guided brain contusion treatment is more favorable than that based on imaging and clinical features remains unknown. We evaluated the effects of a management protocol based on the use of ICP monitoring on functional outcomes in patients with brain contusions.

    Methods: A retrospective cohort study based on two databases was conducted. The patients for brain contusion with volume great than 20ml were included into this study. According to the clinical experience and judgment of the attending physician, patients enrolled in the study were divided into two groups (ICP-monitoring group and imaging–clinical examination group). Patients in the ICP-monitoring group were given immediate ICP monitoring. According to the specific value of ICP and the control situation, the follow-up treatment was determined. In the imaging–clinical examination group, patients were given immediate brain contusion evacuation with or without decompressive craniectomy (DC). ICP monitoring was or was not administered after surgery. A propensity score matching was used to compare the 6-month favorable outcome and prevalence of complications between the two groups.

    Results: After propensity score matching, the six-month favorable outcome rate was 69.2% in the ICP-monitoring group compared with 58.2% in the imaging–clinical examination group (OR, 1.61; 95% CI, 1.10–2.35; P = 0.013). The six-month good recovery rate was 35.0% in the ICP-monitoring group as compared with 18.1% in the imaging–clinical examination group (OR, 2.43; 95% CI, 1.59 to 3.72; P < 0.001).

    Conclusions: For patients with a volume of brain contusion of > 20 mL, care focused on the management protocol based on ICP monitoring was shown to be superior to care based on imaging and clinical examination. The surgical treatment of brain contusion based on ICP monitoring may improve the prognosis of patients.

    Patient Care: The surgical treatment of brain contusion based on ICP monitoring may improve the prognosis of patients, accompanying a decrease in hyperosmolar therapy and DC.

    Learning Objectives: To evaluate the effects of a management protocol based on the use of ICP monitoring on functional outcomes in patients with brain contusions.

    References:

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