Placement of intracranial pressure monitors by non-neurosurgeons

Barber, Marcus A.; Helmer, Stephen D.; Morgan, Jonathan T.; Haan, James M.

doi:10.1097/ta.0b013e318265cb75

Cited by 16 publications

(21 citation statements)

References 7 publications

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“…Yet, the current practice of skilled neurosurgeons being required for invasive skull procedures has been debated in a recent study by Barber et al 32 This study, consisting of patients within a single trauma center, revealed that the placement of ICP monitors may be performed safely by both neurosurgeons and non-neurosurgeons in a trauma center. 33 Given the high transfer rate to definitive care Level I or II trauma centers, as found in this present study, the Barber study results may not be generalized to all non-trauma center environments due to staffing differences at non-trauma centers.…”

Section: Discussionmentioning

confidence: 99%

Hospitalized Traumatic Brain Injury: Low Trauma Center Utilization and High Interfacility Transfers among Older Adults

Faul¹,

Xu²,

Sasser³

2016

Prehospital Emergency Care

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Objective Guidelines suggest that Traumatic Brain Injury (TBI) related hospitalizations are best treated at Level I or II trauma centers because of continuous neurosurgical care in these settings. This population-based study examines TBI hospitalization treatment paths by age groups. Methods Trauma center utilization and transfers by age groups were captured by examining the total number of TBI hospitalizations from National Inpatient Sample (NIS) and the number of TBI hospitalizations and transfers in the Trauma Data Bank National Sample Population (NTDB-NSP). TBI cases were defined using diagnostic codes. Results Of the 351,555 TBI related hospitalizations in 2012, 47.9% (n = 168,317) were directly treated in a Level I or II trauma center, and an additional 20.3% (n = 71,286) were transferred to a Level I or II trauma center. The portion of the population treated at a trauma center (68.2%) was significantly lower than the portion of the U.S. population who has access to a major trauma center (90%). Further, nearly half of all transfers to a Level I or II trauma center were adults aged 55 and older (p < 0.001) and that 20.2% of pediatric patients arrive by non-ambulatory means. Conclusion Utilization of trauma center resources for hospitalized TBIs may be low considering the established lower mortality rate associated with treatment at Level I or II trauma centers. The higher transfer rate for older adults may suggest rapid decline amid an unrecognized initial need for a trauma center care. A better understanding of hospital destination decision making is needed for patients with TBI.

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Section: Discussionmentioning

confidence: 99%

Hospitalized Traumatic Brain Injury: Low Trauma Center Utilization and High Interfacility Transfers among Older Adults

Faul¹,

Xu²,

Sasser³

2016

Prehospital Emergency Care

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“…The reference standard for diagnosing intracranial hypertension is the invasive measurement of ICP using ventricular drains or cerebral catheters and microsensors placed through a burr hole drilled in the skull [ 3 ]. However, invasive ICP measurement may not be available in certain situations, such as in underserved rural areas, in developing countries with limited resources or in settings outside the intensive care unit (ICU) and neurosurgical departments [ 4 ]. In several conditions, such as liver failure, preeclampsia, encephalitis, meningitis and stroke, the role of invasive ICP monitoring is not well established or the risk–benefit ratio remains unclear [ 5 – 9 ].…”

Section: Introductionmentioning

confidence: 99%

Transcranial Doppler as a screening test to exclude intracranial hypertension in brain-injured patients: the IMPRESSIT-2 prospective multicenter international study

et al. 2022

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Background Alternative noninvasive methods capable of excluding intracranial hypertension through use of transcranial Doppler (ICPtcd) in situations where invasive methods cannot be used or are not available would be useful during the management of acutely brain-injured patients. The objective of this study was to determine whether ICPtcd can be considered a reliable screening test compared to the reference standard method, invasive ICP monitoring (ICPi), in excluding the presence of intracranial hypertension. Methods This was a prospective, international, multicenter, unblinded, diagnostic accuracy study comparing the index test (ICPtcd) with a reference standard (ICPi), defined as the best available method for establishing the presence or absence of the condition of interest (i.e., intracranial hypertension). Acute brain-injured patients pertaining to one of four categories: traumatic brain injury (TBI), subarachnoid hemorrhage (SAH), intracerebral hemorrhage (ICH) or ischemic stroke (IS) requiring ICPi monitoring, were enrolled in 16 international intensive care units. ICPi measurements (reference test) were compared to simultaneous ICPtcd measurements (index test) at three different timepoints: before, immediately after and 2 to 3 h following ICPi catheter insertion. Sensitivity, specificity, positive (PPV) and negative predictive values (NPV) were calculated at three different ICPi thresholds (> 20, > 22 and > 25 mmHg) to assess ICPtcd as a bedside real-practice screening method. A receiver operating characteristic (ROC) curve analysis with the area under the curve (AUC) was used to evaluate the discriminative accuracy and predictive capability of ICPtcd. Results Two hundred and sixty-two patients were recruited for final analysis. Intracranial hypertension (> 22 mmHg) occurred in 87 patients (33.2%). The total number of paired comparisons between ICPtcd and ICPi was 687. The NPV was elevated (ICP > 20 mmHg = 91.3%, > 22 mmHg = 95.6%, > 25 mmHg = 98.6%), indicating high discriminant accuracy of ICPtcd in excluding intracranial hypertension. Concordance correlation between ICPtcd and ICPi was 33.3% (95% CI 25.6–40.5%), and Bland–Altman showed a mean bias of -3.3 mmHg. The optimal ICPtcd threshold for ruling out intracranial hypertension was 20.5 mmHg, corresponding to a sensitivity of 70% (95% CI 40.7–92.6%) and a specificity of 72% (95% CI 51.9–94.0%) with an AUC of 76% (95% CI 65.6–85.5%). Conclusions and relevance ICPtcd has a high NPV in ruling out intracranial hypertension and may be useful to clinicians in situations where invasive methods cannot be used or not available. Trial registration: NCT02322970.

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“…Barber et al 13 from Wichita, Kansas, demonstrated safe insertion by both neurosurgeons and nonneurosurgeons and proposed that this procedure be adopted as a core skill for trauma surgeons and surgical residents. Barber et al 13 from Wichita, Kansas, demonstrated safe insertion by both neurosurgeons and nonneurosurgeons and proposed that this procedure be adopted as a core skill for trauma surgeons and surgical residents.…”

Section: Discussionmentioning

confidence: 99%