Comparative Effectiveness of Intracranial Pressure Monitoring on 6-Month Outcomes of Critically Ill Patients With Traumatic Brain Injury
Authors: Nattino Giovanni , Gamberini Lorenzo , Brissy Obou , Carrara Greta , Chesnut Randall , Chiarini Valentina , Chieregato Arturo , Csomos Akos , Fleming Joanne M. , Gradisek Primoz , Kaps Rafael , Kyprianou Theodoros , Lazar Isaac , Lemeshow Stanley , Mikaszewska-Sokolewicz Malgorzata , Paci Giulia , Rossi Carlotta , Temkin Nancy , Xirouchaki Nektaria , Giugni Aimone , Bertolini Guido ,   CREACTIVE Consortium, Agostini Fulvio , Ajmone-Cat Claudio , Bassi Giovanni , Bekos Vasileios , Bellin Marzia , Bocci Maria Grazia , Bonato Valeria , Bonato Alfeo , Bonizzoli Manuela , Bonucci Paola , Bottazzi Andrea , Calamai Italo , Calicchio Giuseppe , Carlin Fabrizia , Casagli Sergio , Castioni Carlo Alberto , Ciceri Rita , Cocciolo Francesco , Crestan Ezio , Csato Gabor , Cseplo Peter , Curto Francesco , Dąbrowski Wojciech , De Cristofaro Anna , De Luca Alessandra , Duda Izabela , Duek Or , Bakó Blanka Emoke , Fagoni Nazzareno , Fassini Paola , Ferri Enrico , Filekovic Suada , Fiore Gilberto , Gamberini Emiliano , Gattari Diego , Gianni Massimo , Dessena Maria Giovanna , Giuntini Romano , Guido Stefania , Gyulai Rita , Hadash Amir , Hribar Renata , Ilia Stavroula , Jankovic Vesna Novak , Jurekovic Vlado , Jereb Mateja , Kapias Maciej , Karadzic Dragica , Kasnik Darja , Vaggelis Volakakis , Szaszi Adrienn Kitti , Kompan Janez , Kyriakides Eraclis , Lagomarsino Silvia , Lamborghini Sara , Livigni Sergio , Malacarne Paolo , Martelli Maria , Martin Marina Alessandra , Martino Costanza , Marudi Andrea , Melis Martina , Mengoli Francesca , Mirkovic Tomislav , Mizak Wiktoria , Munari Marina , Nardai Gabor , Nascimben Ennio , Natalini Giuseppe , Negro Giancarlo , Nemes Csaba , Bernasconi Mara Olga , Pagani Michele , Parrini Vieri , Partala Panagio , Pastorelli Mauro , Pellicioli Isabella , Perino Bert Paolo , Petrucci Nicola , Piva Simone , Poole Daniele , Portolani Laila , Radrizzani Danilo , Rekas Anna , Robak Paweł , Rosano Antonio , Ruggeri Patrizia , Sacchi Marco , Sárkány Ágnes , Skoti Mara , Skrt Alja , Spagarino Ermanno , Sulkowski Wiktor , Szedlák Balázs , Terzitta Marina , Tinturini Rebecca , Tofani Rossella , Tselioti Paraskevi , Vecchiarelli Ada , Venturini Elisabetta , Visconti Salvatore , Zompanti Valeria , Zoppellari Roberto 
Published: September 2023

Importance

While the relationship between persistent elevations in intracranial pressure (ICP) and poorer outcomes is well established for patients with traumatic brain injury (TBI), there is no consensus on how ICP measurements should drive treatment choices, and the effectiveness of ICP monitoring remains unknown.

Objective

To evaluate the effectiveness of ICP monitoring on short- and mid-term outcomes of patients with TBI.

Design, Setting, and Participants

CREACTIVE was a prospective cohort study that started in March 2014 and lasted 5 years. More than 8000 patients with TBI were enrolled at 83 intensive care units (ICUs) from 7 countries who joined the CREACTIVE Consortium. Patients with TBI who met the Brain Trauma Foundation guidelines for ICP monitoring were selected for the current analyses, which were performed from January to November 2022.

Exposure

Patients who underwent ICP monitoring within 2 days of injury (exposure group) were propensity score–matched to patients who were not monitored or who underwent monitoring 2 days after the injury (control group).

Main Outcome and Measure

Functional disability at 6 months as indicated by Glasgow Outcome Scale–Extended (GOS-E) score.

Results

A total of 1448 patients from 43 ICUs in Italy and Hungary were eligible for analysis. Of the patients satisfying the ICP-monitoring guidelines, 503 (34.7%) underwent ICP monitoring (median [IQR] age: 45 years [29-61 years]; 392 males [77.9%], 111 females [22.1%]) and 945 were not monitored (median [IQR] age: 66 years [48-78 years]; 656 males [69.4%], 289 females [30.6%]). After matching to balance the variables, worse 6-month recovery was observed for monitored patients compared with nonmonitored patients (death/vegetative state: 39.2% vs 40.6%; severe disability: 33.2% vs 25.4%; moderate disability: 15.7% vs 14.9%; good recovery: 11.9% vs 19.1%, respectively; P = .005). Monitored patients received medical therapies significantly more frequently.

Conclusions and Relevance

In this cohort study, ICP monitoring was associated with poorer recovery and more frequent medical interventions with their relevant adverse effects. Optimizing the value of ICP monitoring for TBI requires further investigation on monitoring indications, clinical interventions, and management protocols.