Comparative effectiveness of intracranial hypertension management guided by ventricular versus intraparenchymal pressure monitoring: a CENTER-TBI study
Authors: Volovici Victor , Pisică Dana , Gravesteijn Benjamin Y. , Dirven Clemens M. F. , Steyerberg Ewout W. , Ercole Ari , Stocchetti Nino , Nelson David , Menon David K. , Citerio Giuseppe , van der Jagt Mathieu , Maas Andrew I. R. , Haitsma Iain K. , Lingsma Hester F. ,   on behalf of CENTER-TBI investigators, participants for the ICU stratum, Åkerlund Cecilia , Amrein Krisztina , Andelic Nada , Andreassen Lasse , Audibert Gérard , Azouvi Philippe , Azzolini Maria Luisa , Bartels Ronald , Beer Ronny , Bellander Bo-Michael , Benali Habib , Berardino Maurizio , Beretta Luigi , Beqiri Erta , Blaabjerg Morten , Lund Stine Borgen , Brorsson Camilla , Buki Andras , Cabeleira Manuel , Caccioppola Alessio , Calappi Emiliana , Calvi Maria Rosa , Cameron Peter , Lozano Guillermo Carbayo , Castaño-León Ana M. , Cavallo Simona , Chevallard Giorgio , Chieregato Arturo , Coburn Mark , Coles Jonathan , Cooper Jamie D. , Correia Marta , Czeiter Endre , Czosnyka Marek , Dahyot-Fizelier Claire , Dark Paul , De Keyser Véronique , Degos Vincent , Corte Francesco Della , Boogert Hugo den , Depreitere Bart , Dilvesi Dula , Dixit Abhishek , Dreier Jens , Dulière Guy-Loup , Ezer Erzsébet , Fabricius Martin , Foks Kelly , Frisvold Shirin , Furmanov Alex , Galanaud Damien , Gantner Dashiell , Ghuysen Alexandre , Giga Lelde , Golubovic Jagos , Gomez Pedro A. , Grossi Francesca , Gupta Deepak , Haitsma Iain , Helseth Eirik , Hutchinson Peter J. , Jankowski Stefan , Johnson Faye , Karan Mladen , Kolias Angelos G. , Kondziella Daniel , Koraropoulos Evgenios , Koskinen Lars-Owe , Kovács Noémi , Kowark Ana , Lagares Alfonso , Laureys Steven , Ledoux Didier , Lejeune Aurelie , Lightfoot Roger , Manara Alex , Martino Costanza , Maréchal Hugues , Mattern Julia , McMahon Catherine , Menovsky Tomas , Misset Benoit , Muraleedharan Visakh , Murray Lynnette , Negru Ancuta , Newcombe Virginia , Nyirádi József , Ortolano Fabrizio , Payen Jean-François , Perlbarg Vincent , Persona Paolo , Piippo-Karjalainen Anna , Ples Horia , Pomposo Inigo , Posti Jussi P. , Puybasset Louis , Radoi Andreea , Ragauskas Arminas , Raj Rahul , Rhodes Jonathan , Richter Sophie , Rocka Saulius , Roe Cecilie , Roise Olav , Rosenfeld Jeffrey V. , Rosenlund Christina , Rosenthal Guy , Rossaint Rolf , Rossi Sandra , Sahuquillo Juan , Sandrød Oddrun , Sakowitz Oliver , Sanchez-Porras Renan , Schirmer-Mikalsen Kari , Schou Rico Frederik , Smielewski Peter , Sorinola Abayomi , Stamatakis Emmanuel , Sundström Nina , Takala Riikka , Tamás Viktória , Tamosuitis Tomas , Tenovuo Olli , Thomas Matt , Tibboel Dick , Tolias Christos , Trapani Tony , Tudora Cristina Maria , Vajkoczy Peter , Vallance Shirley , Valeinis Egils , Vámos Zoltán , Van der Steen Gregory , van Wijk Roel P. J. , Vargiolu Alessia , Vega Emmanuel , Vik Anne , Vilcinis Rimantas , Vulekovic Petar , Williams Guy , Winzeck Stefan , Wolf Stefan , Younsi Alexander , Zeiler Frederick A. , Ziverte Agate , Clusmann Hans , Voormolen Daphne , van Dijck Jeroen T. J. M. , van Essen Thomas A. 
Published: June 2022

Abstract
Objective

To compare outcomes between patients with primary external ventricular device (EVD)–driven treatment of intracranial hypertension and those with primary intraparenchymal monitor (IP)–driven treatment.

Methods
The CENTER-TBI study is a prospective, multicenter, longitudinal observational cohort study that enrolled patients of all TBI severities from 62 participating centers (mainly level I trauma centers) across Europe between 2015 and 2017. Functional outcome was assessed at 6 months and a year. We used multivariable adjusted instrumental variable (IV) analysis with “center” as instrument and logistic regression with covariate adjustment to determine the effect estimate of EVD on 6-month functional outcome.

Results
A total of 878 patients of all TBI severities with an indication for intracranial pressure (ICP) monitoring were included in the present study, of whom 739 (84%) patients had an IP monitor and 139 (16%) an EVD. Patients included were predominantly male (74% in the IP monitor and 76% in the EVD group), with a median age of 46 years in the IP group and 48 in the EVD group. Six-month GOS-E was similar between IP and EVD patients (adjusted odds ratio (aOR) and 95% confidence interval [CI] OR 0.74 and 95% CI [0.36–1.52], adjusted IV analysis). The length of intensive care unit stay was greater in the EVD group than in the IP group (adjusted rate ratio [95% CI] 1.70 [1.34–2.12], IV analysis). One hundred eighty-seven of the 739 patients in the IP group (25%) required an EVD due to refractory ICPs.

Conclusion
We found no major differences in outcomes of patients with TBI when comparing EVD-guided and IP monitor–guided ICP management. In our cohort, a quarter of patients that initially received an IP monitor required an EVD later for ICP control. The prevalence of complications was higher in the EVD group.

Protocol
The core study is registered with ClinicalTrials.gov, number NCT02210221, and the Resource Identification Portal (RRID: SCR_015582).