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    Factors associated with receipt of intracranial pressure monitoring in older adults with traumatic brain injury

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    Author
    Ghneim, Mira
    Albrecht, Jennifer
    Brasel, Karen
    Knight, Ariel
    Liveris, Anna
    Watras, Jill
    Michetti, Christopher P
    Haan, James
    Lightwine, Kelly
    Winfield, Robert D
    Adams, Sasha D
    Podbielski, Jeanette
    Armen, Scott
    Zacko, J Christopher
    Nasrallah, Fady S
    Schaffer, Kathryn B
    Dunn, Julie A
    Smoot, Brittany
    Schroeppel, Thomas J
    Stillman, Zachery
    Cooper, Zara
    Stein, Deborah M
    Show allShow less

    Date
    2021-07-23
    Journal
    Trauma Surgery & Acute Care Open
    Publisher
    BMJ Publishing Group
    Type
    Article
    
    Metadata
    Show full item record
    See at
    https://doi.org/10.1136/tsaco-2021-000733
    Abstract
    Background: The Brain Trauma Foundation (BTF) Guidelines for the Management of Severe Traumatic Brain Injury (TBI) include intracranial pressure monitoring (ICPM), yet very little is known about ICPM in older adults. Our objectives were to characterize the utilization of ICPM in older adults and identify factors associated with ICPM in those who met the BTF guidelines. Methods: We analyzed data from the American Association for the Surgery of Trauma Geriatric TBI Study, a registry study conducted among individuals with isolated, CT-confirmed TBI across 45 trauma centers. The analysis was restricted to those aged ≥60. Independent factors associated with ICPM for those who did and did not meet the BTF guidelines were identified using logistic regression. Results: Our sample was composed of 2303 patients, of whom 66 (2.9%) underwent ICPM. Relative to Glasgow Coma Scale (GCS) score of 13 to 15, GCS score of 9 to 12 (OR 10.2; 95% CI 4.3 to 24.4) and GCS score of <9 (OR 15.0; 95% CI 7.2 to 31.1), intraventricular hemorrhage (OR 2.4; 95% CI 1.2 to 4.83), skull fractures (OR 3.6; 95% CI 2.0 to 6.6), CT worsening (OR 3.3; 95% CI 1.8 to 5.9), and neurosurgical interventions (OR 3.8; 95% CI 2.1 to 7.0) were significantly associated with ICPM. Restricting to those who met the BTF guidelines, only 43 of 240 (18%) underwent ICPM. Factors independently associated with ICPM included intraparenchymal hemorrhage (OR 2.2; 95% CI 1.0 to 4.7), skull fractures (OR 3.9; 95% CI 1.9 to 8.2), and neurosurgical interventions (OR 3.5; 95% CI 1.7 to 7.2). Discussion: Worsening GCS, intraparenchymal/intraventricular hemorrhage, and skull fractures were associated with ICPM among older adults with TBI, yet utilization of ICPM remains low, especially among those meeting the BTF guidelines, and potential benefits remain unclear. This study highlights the need for better understanding of factors that influence compliance with BTF guidelines and the risks versus benefits of ICPM in this population. Level of evidence: Prognostic and epidemiological, level III.
    Rights/Terms
    © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
    Keyword
    brain injuries
    geriatrics
    intracranial pressure
    traumatic
    Identifier to cite or link to this item
    http://hdl.handle.net/10713/16440
    ae974a485f413a2113503eed53cd6c53
    10.1136/tsaco-2021-000733
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