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

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

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish (US)
Article numbere000733
JournalTrauma Surgery and Acute Care Open
Volume6
Issue number1
DOIs
StatePublished - Jul 23 2021

All Science Journal Classification (ASJC) codes

  • Surgery
  • Critical Care and Intensive Care Medicine

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