Agrawal Deepak, Raghavendran Krishnan, Schaubel Douglas E, Mishra Mahesh C, Rajajee Venkatakrishna
1 JPN Apex Trauma Center and Neurosciences Center , Ansari Nagar, India .
2 Department of Surgery, University of Michigan , Ann Arbor, Michigan.
J Neurotrauma. 2016 May 1;33(9):853-8. doi: 10.1089/neu.2015.4015. Epub 2015 Oct 8.
Although a recent clinical trial (BEST TRIP) demonstrated no improvement in outcomes with invasive intracranial pressure (ICP) monitoring (ICPM) following severe traumatic brain injury (TBI), its generalizability has been called into question. In several global settings ICPM is not the standard of care and is used at the discretion of the attending neurosurgeon. Our objective was to determine the impact of ICPM on mortality and 6-month functional outcomes following severe TBI. The setting was a referral trauma center with 36 intensive care unit (ICU) beds and 300-600 TBI admissions per year. During a 2-year period data were prospectively entered into a severe TBI registry. Patients with severe TBI aged >12 years meeting Brain Trauma Foundation (BTF) criteria for ICPM were included in the study. Outcomes of interest were in-hospital mortality and poor 6-month functional outcome defined as Glasgow Outcome Scale (GOS) score of 3 or lower. A propensity score based analysis incorporating known predictors of outcome in TBI was utilized to examine the impact of ICPM on outcomes. Of 1345 patients meeting study criteria 497 (37%) underwent ICPM. In-hospital mortality was 35% (471/1345). Of 454 patients for whom 6-month outcome was available, 161 (35%) suffered a poor functional outcome. Following propensity score analysis ICPM use was associated with an 8% (p = 0.002) decrease in mortality but no significant effect (p = 0.2) on functional outcome. The use of ICPM following severe TBI was associated with decreased in-hospital mortality. Further clinical trials of ICPM in TBI may be warranted.
尽管最近一项临床试验（BEST TRIP）表明，严重创伤性脑损伤（TBI）后进行有创颅内压（ICP）监测（ICPM）并未改善预后，但其普遍性受到了质疑。在一些全球范围内，ICPM并非标准治疗方法，由主治神经外科医生酌情使用。我们的目的是确定ICPM对严重TBI后死亡率和6个月功能预后的影响。研究地点是一家拥有36张重症监护病房（ICU）床位、每年收治300 - 600例TBI患者的转诊创伤中心。在两年期间，前瞻性地将数据录入严重TBI登记册。年龄大于12岁、符合脑创伤基金会（BTF）ICPM标准的严重TBI患者纳入研究。感兴趣的结局指标是住院死亡率和6个月功能预后不良，定义为格拉斯哥预后评分（GOS）为3分或更低。采用纳入TBI已知预后预测因素的倾向评分分析来检验ICPM对预后的影响。在1345例符合研究标准的患者中，497例（37%）接受了ICPM。住院死亡率为35%（471/1345）。在454例有6个月预后数据的患者中，161例（35%）功能预后不良。倾向评分分析后发现，使用ICPM与死亡率降低8%（p = 0.002）相关，但对功能预后无显著影响（p = 0.2）。严重TBI后使用ICPM与住院死亡率降低相关。可能有必要对TBI患者进行ICPM的进一步临床试验。
