J Neurosurg. 2018 Mar;128(3):828-833. doi: 10.3171/2016.11.JNS162198. Epub 2017 May 26.
OBJECTIVE Intracranial pressure (ICP) monitoring has become the standard of care in the management of severe head trauma. Intraventricular devices (IVDs) and intraparenchymal devices (IPDs) are the 2 most commonly used techniques for ICP monitoring. Despite the widespread use of these devices, very few studies have investigated the effect of device type on outcomes. The purpose of the present study was to compare outcomes between 2 types of ICP monitoring devices in patients with isolated severe blunt head trauma. METHODS This retrospective observational study was based on the American College of Surgeons Trauma Quality Improvement Program database, which was searched for all patients with isolated severe blunt head injury who had an ICP monitor placed in the 2-year period from 2013 to 2014. Extracted variables included demographics, comorbidities, mechanisms of injury, head injury specifics (epidural, subdural, subarachnoid, intracranial hemorrhage, and diffuse axonal injury), Abbreviated Injury Scale (AIS) score for each body area, Injury Severity Score (ISS), vital signs in the emergency department, and craniectomy. Outcomes included 30-day mortality, complications, number of ventilation days, intensive care unit and hospital lengths of stay, and functional independence. RESULTS During the study period, 105,721 patients had isolated severe traumatic brain injury (head AIS score ≥ 3). Overall, an ICP monitoring device was placed in 2562 patients (2.4%): 1358 (53%) had an IVD and 1204 (47%) had an IPD. The severity of the head AIS score did not affect the type of ICP monitoring selected. There was no difference in the median ISS; ISS > 15; head AIS Score 3, 4, or 5; or the need for craniectomy between the 2 device groups. Unadjusted 30-day mortality was significantly higher in the group with IVDs (29% vs 25.5%, p = 0.046); however, stepwise logistic regression analysis showed that the type of ICP monitoring was not an independent risk factor for death, complications, or functional outcome at discharge. CONCLUSIONS This study demonstrated that compliance with the Brain Trauma Foundation guidelines for ICP monitoring is poor. In isolated severe blunt head injuries, the type of ICP monitoring device does not have any effect on survival, systemic complications, or functional outcome.
目的 颅内压（ICP）监测已成为严重颅脑外伤管理的标准治疗方法。脑室内装置（IVD）和脑实质内装置（IPD）是最常用于 ICP 监测的两种技术。尽管这些设备得到了广泛的应用，但很少有研究调查设备类型对结果的影响。本研究旨在比较两种 ICP 监测设备在单纯严重钝性颅脑外伤患者中的效果。 方法 本回顾性观察性研究基于美国外科医师学会创伤质量改进计划数据库，该数据库检索了 2013 年至 2014 年期间 2 年内所有接受 ICP 监测的单纯严重钝性颅脑损伤患者。提取的变量包括人口统计学、合并症、损伤机制、颅脑损伤具体情况（硬膜外、硬膜下、蛛网膜下腔、颅内出血和弥漫性轴索损伤）、每个身体区域的简明损伤评分（AIS）、损伤严重程度评分（ISS）、急诊科生命体征和颅骨切开术。结果包括 30 天死亡率、并发症、通气天数、重症监护病房和医院住院时间、功能独立性。 结果 在研究期间，105721 例患者发生单纯严重创伤性脑损伤（头部 AIS 评分≥3）。总体而言，有 2562 例患者（2.4%）放置了 ICP 监测装置：1358 例（53%）使用 IVD，1204 例（47%）使用 IPD。ICP 监测装置的选择不受头部 AIS 评分严重程度的影响。两组间的中位 ISS 无差异；ISS>15；头部 AIS 评分 3、4 或 5；或需要颅骨切开术。IVD 组 30 天死亡率明显较高（29%比 25.5%，p=0.046）；然而，逐步逻辑回归分析表明，ICP 监测类型不是死亡、并发症或出院时功能结局的独立危险因素。 结论 本研究表明，颅内压监测符合颅脑创伤基金会指南的情况较差。在单纯严重钝性颅脑损伤中，ICP 监测装置的类型对生存率、全身并发症或功能结局没有影响。
