Title Comparative effectiveness of intracranial hypertension management guided by ventricular versus intraparenchymal pressure monitoring: a CENTER-TBI study /
Authors Volovici, Victor ; Pisica, 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
DOI 10.1007/s00701-022-05257-z
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Is Part of Acta neurochirurgica.. Wien : Springer. 2022, vol. 164, iss. 7, p. 1693-1705.. ISSN 0001-6268. eISSN 0942-0940
Keywords [eng] external ventricular devices ; intraparenchymal monitors ; intracranial pressure monitoring ; severe TBI ; traumatic brain injury ; CENTER-TBI ; Intracranial hypertension ; EVD ; ICP
Abstract [eng] 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.
Published Wien : Springer
Type Journal article
Language English
Publication date 2022
CC license CC license description