Intracranial pressure monitoring in severe

head injury: compliance with Brain Trauma

Foundation guidelines and effect on outcomes:
a prospective study
{ Journal Reading Jessica 112016110
 Peep Talving, M.D., Ph.D.,
Efstathios Karamanos, M.D.,
Pedro G. Teixeira, M.D.,
Dimitra Skiada, M.D.,
Lydia Lam, M.D.,
Howard Belzberg, M.D.,
Kenji Inaba, M.D.,
and Demetrios Demetriades, M.D., Ph.D.
Division of Acute Care Surgery (Trauma, Emergency Surgery and
Surgical Critical Care), Department of
Surgery, Keck School of Medicine, Los Angeles County + University
of Southern California Medical Center,
Los Angeles, California

Author
 Traumatic Brain Injury (TBI) is the major cause of
mortality and morbidity in civilian and military settings.
Incidence and risk of intracranial hypertension after TBI
has been documented and thus Brain Trauma
Foundation (BTF) guideline recommended intracranial
pressure (ICP) monitoring in comatose patient who have
sustained severe head injury.

Hypothesis: compliance with BTF ICP

monitoring guideline is associated with
improved outcomes.

Introduction
 Study design: prospective observational study

Location: Surgical ICU at Los Angeles County and

University of Southern California Medical Center

Time: January 1 2010 until December 30 2011

Sample: Trauma patients with severe blunt TBI

(GCS 8 and AIS 3) who met BTF inclusion criteria
for ICP monitoring

Exclusion criteria: pediatric population ( age 18 years),

patient who were moribund, and those not expected to
improve prior to the decision of whether an ICP
monitoring devices would be planted.

Method
 Data collected:
Sex, age, blood pressure on admission, GCS
score on admission, ISS (injury severity score),
AIS for each body region, type of intracranial
injury, ICP value in patient undergoing
intervention, Intracranial hemorrhage
treatment modalities, and neurosurgical
documentation for omission of ICP monitoring.

The sample is divided into two, those who are

subjected to ICP monitoring and those not
undergoing ICP monitoring

Method
 216 patients who sustained a severe TBI met
the BTF guidelines for ICP monitoring

A total of 46.8% of patients who met the BTF

criteria underwent ICP monitoring (n = 101).
A Becker ventriculostomy EMDS II (Medtronic
Corp.) was placed in 60 patients (59%)
A transducer-tipped pressure/temperature
fiberoptic catheter Camino Advanced Monitor
(bolt) (Integra LifeSciences Corp.) was placed
in 41 patients (41%)

Result
 The most common reason for not placing an
ICP monitoring device was the treating
physicians decision (89.6%), followed by
decompressive surgery (13.9%) and expectation
of a rapid improvement (4.3%).

Result
Result
Result
Result
 In brain injuries that are likely to require aggressive
ICP management, a ventriculostomy is placed,
which can also provide CSF drainage. Patients not
likely to require CSF drainage are subjected to
placement of a fiberoptic ICP monitoring device,
allowing continuous ICP monitoring.

we observed the prevalence of ICP monitoring in

patients meeting BTF guideline criteria at 46.8%. In
our prospective study we documented reasons for
omission of ICP monitoring, which included
neurosurgeons discretion, decompressive
craniotomy/ craniectomy precluding the need for an
ICP device, and expectation of rapid neurological
recovery

Discussion
 ICP monitoring experienced a significant
overall mortality reduction effect of 69% after
adjustment for most clinically relevant
confounders including head injury severity.

Discussion
 Compliance with the BTF ICP monitoring
guidelines in our study sample was 46.8%.
Compliance with these guidelines was
associated with improved survival.

Conclusion
Thank You
{ For your atttention