TY - JOUR
T1 - Comparative effectiveness of intracranial hypertension management guided by ventricular versus intraparenchymal pressure monitoring
T2 - a CENTER-TBI study
AU - Volovici, Victor
AU - Pisică, Dana
AU - Gravesteijn, Benjamin Y
AU - Dirven, Clemens M F
AU - Steyerberg, Ewout W
AU - Ercole, Ari
AU - Stocchetti, Nino
AU - Nelson, David
AU - Menon, David K
AU - Citerio, Giuseppe
AU - van der Jagt, Mathieu
AU - Maas, Andrew I R
AU - Haitsma, Iain K
AU - Lingsma, Hester F
AU - CENTER-TBI investigators, participants for the ICU stratum
A2 - Kondziella, Daniel
A2 - Fabricius, Martin Ejler
N1 - © 2022. The Author(s).
PY - 2022/7
Y1 - 2022/7
N2 - 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).
AB - 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).
KW - Brain Injuries, Traumatic/complications
KW - Female
KW - Hemorrhagic Fever, Ebola/complications
KW - Humans
KW - Intracranial Hypertension/complications
KW - Intracranial Pressure
KW - Male
KW - Middle Aged
KW - Monitoring, Physiologic
KW - Prospective Studies
UR - http://www.scopus.com/inward/record.url?scp=85131406979&partnerID=8YFLogxK
U2 - 10.1007/s00701-022-05257-z
DO - 10.1007/s00701-022-05257-z
M3 - Journal article
C2 - 35648213
SN - 0001-6268
VL - 164
SP - 1693
EP - 1705
JO - Acta Neurochirurgica
JF - Acta Neurochirurgica
IS - 7
ER -