Aziz Peter, Muller Alison, Butts Christopher, Reilly Eugene F, Martin Anthony, Lawson Christopher, Geng Thomas A, Ong Adrian W
Drexel University College of Medicine at Tower Health, Wyomissing, Pennsylvania.
Division of Trauma and Critical Care, Department of Surgery, Reading Hospital, West Reading, Pennsylvania.
J Surg Res. 2025 Feb;306:344-349. doi: 10.1016/j.jss.2024.12.045. Epub 2025 Jan 21.
It is unclear if intracranial pressure monitoring (ICPM) after open cranial procedures (craniotomy or craniectomy) (OC) for traumatic brain injury is associated with mortality. We hypothesized that ICPM placed early after OC was associated with lower mortality compared to no ICPM or delayed ICPM placement.
Using 2020-2021 data from the American College of Surgeons Trauma Quality Improvement Program, patients ≥16 y from level 1 and 2 trauma centers who underwent OC were divided into two groups: ICPM placed within 72 h of OC (early) and no ICPM or ICPM placed after 72 h (none/delayed). Outcome was in-hospital mortality. Logistic regression was used to elucidate predictors of mortality.
A total of 19,830 patients (early ICPM, 29%) were included. Early patients were more likely to be from level 1 centers (63% versus 60%, P = 0.004), younger (median age 47 versus 60, P < 0.0001), to have a lower Glasgow Coma Score (median, 6 versus 14, P < 0.0001), higher injury severity score (median, 26 versus 26, P < 0.0001), an unreactive pupil (33% versus 18%, P < 0.0001), midline shift >5 mm (69% versus 60%, P < 0.0001), received ≥2 units of blood/first 4 h (14% versus 6%, P < 0.0001) and higher mortality (31% versus 19%, P < 0.0001) compared to none/delayed patients. Controlled for significant variables, early ICPM was associated with increased mortality (odds ratio 1.35, 95% confidence interval 1.24-1.47). Analysis of subjects with isolated brain injury found a similar association (odds ratio 1.32, 95% C1 1.15-1.52).
ICPM placed within 72 h of OC was associated with increased mortality. Indications for ICPM after OC should be investigated further in multicenter prospective studies.
对于创伤性脑损伤行开颅手术（颅骨切开术或颅骨切除术）（OC）后进行颅内压监测（ICPM）是否与死亡率相关尚不清楚。我们假设与未进行ICPM或延迟放置ICPM相比，OC后早期放置ICPM与较低的死亡率相关。
利用美国外科医师学会创伤质量改进项目2020 - 2021年的数据，将来自1级和2级创伤中心、年龄≥16岁且接受OC的患者分为两组：OC后72小时内放置ICPM（早期）组和未放置ICPM或72小时后放置ICPM（无/延迟）组。结局指标为院内死亡率。采用逻辑回归分析来阐明死亡率的预测因素。
共纳入19830例患者（早期ICPM组占29%）。与无/延迟组患者相比，早期组患者更可能来自1级中心（63%对60%，P = 0.004），更年轻（中位年龄47岁对60岁，P < 0.0001），格拉斯哥昏迷评分更低（中位值6对14，P < 0.0001），损伤严重程度评分更高（中位值26对26，P < 0.0001），瞳孔无反应（33%对18%，P < 0.0001），中线移位>5mm（69%对60%，P < 0.0001），在最初4小时内接受≥2单位血液输注（14%对6%，P < 0.0001）以及死亡率更高（31%对19%，P < 0.0001）。在控制了显著变量后，早期ICPM与死亡率增加相关（比值比1.35，95%置信区间1.24 - 1.47）。对单纯脑损伤患者的分析发现了类似的关联（比值比1.32，95%CI 1.15 - 1.52）。
OC后72小时内放置ICPM与死亡率增加相关。OC后ICPM的适应证应在多中心前瞻性研究中进一步探讨。
