Intraventricular intracranial pressure monitoring improves the outcome of older adults with severe traumatic brain injury: an observational, prospective study

You, Wendong; Feng, Junfeng; Tang, Qilin; Cao, Jun; Wang, Lei; Jin, Lei; Mao, Qing; Gao, Guoyi; Jiang, Jiyao

doi:10.1186/s12871-016-0199-9

Cited by 38 publications

(33 citation statements)

References 32 publications

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“…Our results are compatible with findings in other observational studies, indicating that ICP monitoring is benefi- cial for patients with severe TBI fulfilling the BTF criteria for ICP monitoring. 1,8,14,17,30,31 Moreover, in a recent metaanalysis of both observational and randomized controlled trials, the use of ICP monitors was found to be beneficial. 24 The heterogeneity in the effect of ICP monitors on outcome in the observational studies is perplexing.…”

Section: Discussionmentioning

confidence: 99%

The effect of ICP monitoring in severe traumatic brain injury: a propensity score–weighted and adjusted regression approach

Rønning¹,

Helseth

Skaga

et al. 2019

Journal of Neurosurgery

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OBJECTIVEThe use of intracranial pressure (ICP) monitoring has been postulated to be beneficial in patients with severe traumatic brain injury (TBI), although studies investigating this hypothesis have reported conflicting results. The objective of this study was to evaluate the effect of inserting an ICP monitor on survival in patients with severe TBI.METHODSThe Oslo University Hospital trauma registry was searched for the records of all patients admitted between January 1, 2002, and December 31, 2013, who fulfilled the Brain Trauma Foundation criteria for intracranial hypertension and who survived at least 24 hours after admission. The impact of ICP monitoring was investigated using both a logistic regression model and a multiple imputed, propensity score–weighted logistic regression analysis.RESULTSThe study involved 1327 patients, in which 757 patients had an ICP monitor implanted. The use of ICP monitors significantly increased in the study period (p < 0.01). The 30-day overall mortality was 24.3% (322 patients), divided into 35.1% (200 patients, 95% confidence interval [CI] 31.3%–39.1%) in the group without an ICP monitor and 16.1% (122 patients, 95% CI 13.6%–18.9%) in the group with an ICP monitor. The impact of ICP monitors on 30-day mortality was found to be beneficial both in the complete case analysis logistic regression model (odds ratio [OR] 0.23, 95% CI 0.16–0.33) and in the adjusted, aggregated, propensity score–weighted imputed data sets (OR 0.22, 95% CI 0.15–0.35; both p < 0.001). The sensitivity analysis indicated that the findings are robust to unmeasured confounders.CONCLUSIONSThe authors found that the use of an ICP monitor is significantly associated with improved survival in patients with severe head injury.

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Section: Discussionmentioning

confidence: 99%

The effect of ICP monitoring in severe traumatic brain injury: a propensity score–weighted and adjusted regression approach

Rønning¹,

Helseth

Skaga

et al. 2019

Journal of Neurosurgery

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“…Recent studies focusing on specific age demographics again had mixed results, however. These include an observational study showing improved hospital and 6-month mortality with ICP monitor placement in the elderly,7 as compared with a 2007–2008 NTDB study that did not find a survival benefit in patients over 55 years 5…”

Section: Discussionmentioning

confidence: 99%

“…This elevated mortality rate has been attributed to the higher risk of falls in this age group. Despite the high risk of mortality in elderly patients with severe TBI, the evidence for ICP monitor efficacy in this subgroup is limited 7. There is a void in the literature on the effect of ICP monitoring specifically in the elderly, as well as whether or not deferring ICP monitor placement in these patients is appropriate.…”

Section: Introductionmentioning

confidence: 99%

Respect your elders: effects of ageing on intracranial pressure monitor use in traumatic brain injury

Schüpper

Berndtson

Smith

et al. 2019

Trauma Surg Acute Care Open

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BackgroundThe Brain Trauma Foundation recommends intracranial pressure (ICP) monitor placement for patients with severe traumatic brain injury (TBI). Adherence with these guidelines in elderly patients is unknown. We hypothesized that disparities in ICP monitor placement would exist based on patient age.MethodsUsing the National Trauma Data Bank (2010–2014), we identified patients admitted for blunt TBI with admission Glasgow Coma Scale (GCS) scores of 3–8. Patients were excluded if they had a non-Head Abbreviated Injury Scale (AIS) score ≥3, hospital length of stay <24 hours or were discharged from the emergency department. Demographic data, ICP monitor placement, GCS, AIS-Head, Injury Severity Score, and outcome measures were collected. Propensity score matching between ICP monitor and non-ICP monitor patients was used for logistic regression and Cox multivariate regression analyses.ResultsOf the 30 710 patients with blunt TBI with GCS scores of 3–8 included in our study, 4093 were treated with an ICP monitor. ICP monitor placement rates significantly decreased with increasing age. Multivariable analysis demonstrated that patients treated with an ICP monitor were more likely to be younger, male, have private/commercial insurance, and receive care at an institution with three or more neurosurgeons.ConclusionPatients ≥65 years of age with severe blunt TBI are less likely to be treated with an ICP monitor than younger patients. Age disparities in adherence to Brain Trauma Foundation guidelines may alter the outcomes for patients with severe TBI.Level of evidenceLevel IV.

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“…9,10,14 The outcome of ICP monitoring in elderly is controversial, with some studies in favour andothers showing no major benefit. 32,33 Anticoagulant agents such as warfarin are associated with increased mortality, but such is not observed with antiplatelet agents especially when surgical imtervemtion is required. 34,35 The risk of post-traumatic epilepsy is higher in elderly and also the risk of delayed seizures is greater than early seizures when compared to younger adults.…”

Section: Discussionmentioning

confidence: 99%

Geriatric head injuries: impact and outcomes

et al. 2019

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Background: Elderly trauma patients present unique challenges and face more significant obstacles in recovery than their younger counterparts. They usually experience higher morbidity and mortality and slower recovery trajectories and have, on average, worse functional, cognitive, and psychosocial outcomes months or years post-injury than do younger patients.Methods: Authors conducted a study of elderly head injury patients to understand the epidemiology of geriatric TBI, the impact of comorbidities and management issues and outcomes in such patients. Authors had a total of 110 patients who presented with traumatic brain injury and were admitted in this hospital over 2 years. Authors also reviewed the literatures to study the factors affecting outcome after geriatric TBI and studied the role of aggressive neurosurgical management in geriatric TBI.Results: Among 68%(n=75) of the patients were male and 32% females. Age group of 60-65 years was the highest with 60.9% patients. Patients with GCS of 8 and below had the highest mortality rates of 68 %. Overall mortality rate was 32.72% and 9.09 % of the patients survived in a vegetative condition. The proportion of injury secondary to fall was the largest single group in 50.9% patients, and Chronic SDH was the most common pathology seen in 36.45 % patients. Highest mortality was seen in patients with Diffuse Axonal Injury (69.23 %). Out of the 110 patients , 57 patients underwent surgery for various pathologies. Chronic SDH were the most common operated pathology followed by acute SDH. Glassgow outcome scale was used as the measure of outcome in these series of patients. 32.72 % patients had a GOS score of 1 and 9.09 % had a score of 2. 18.18 % patients remained severely disabled with a score of 3 and nine patients (8.18 %) had a score of 4 and thirty five patients had good recovery (GOS-5).Conclusions: Due to the better treatment options there is an increase in the number of elderly around the world. Thus, the number of eldery individuals presenting with TBI to the emergency department is also on the rise more commonly due to falls than road traffic accidents. There is a need for specific prognostic and management guidelines for the elderly which can lead to better diagnosis, care and recovery and eventual short- and long-term outcomes in the elderly.

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Intraventricular intracranial pressure monitoring improves the outcome of older adults with severe traumatic brain injury: an observational, prospective study

Cited by 38 publications

References 32 publications

The effect of ICP monitoring in severe traumatic brain injury: a propensity score–weighted and adjusted regression approach

The effect of ICP monitoring in severe traumatic brain injury: a propensity score–weighted and adjusted regression approach

Respect your elders: effects of ageing on intracranial pressure monitor use in traumatic brain injury

Geriatric head injuries: impact and outcomes

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