More fateful than fruitful? Intracranial pressure monitoring in elderly patients with traumatic brain injury is associated with worse outcomes
Abstract Background In an expanding elderly population, traumatic brain injury (TBI) remains a significant cause of death and disability. Guidelines for management of TBI, according to the Brain Trauma Foundation (BTF), include intracranial pressure (ICP) monitoring. Whether ICP monitoring contribut...
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| Veröffentlicht in: | The Journal of surgical research 2015-10, Vol.198 (2), p.482-488 |
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| creator | Dang, Quoc, DO Simon, Joshua, DO Catino, Joe, MD Puente, Ivan, MD Habib, Fahim, MD Zucker, Lloyd, MD Bukur, Marko, MD |
| description | Abstract Background In an expanding elderly population, traumatic brain injury (TBI) remains a significant cause of death and disability. Guidelines for management of TBI, according to the Brain Trauma Foundation (BTF), include intracranial pressure (ICP) monitoring. Whether ICP monitoring contributes to outcomes in the elderly patients with TBI has not been explored. Methods This is a retrospective study extracted from the National Trauma Database 2007–2008 research datasets. Patients were included if aged >55 y and they met BTF indications for ICP monitoring. Patients that had nonsurvivable injuries (any body region, abbreviated injury score = 6), were dead on arrival, had withdrawal of care, or length of stay |
| doi_str_mv | 10.1016/j.jss.2015.03.092 |
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Intracranial pressure monitoring in elderly patients with traumatic brain injury is associated with worse outcomes</title><source>MEDLINE</source><source>Elsevier ScienceDirect Journals Complete</source><creator>Dang, Quoc, DO ; Simon, Joshua, DO ; Catino, Joe, MD ; Puente, Ivan, MD ; Habib, Fahim, MD ; Zucker, Lloyd, MD ; Bukur, Marko, MD</creator><creatorcontrib>Dang, Quoc, DO ; Simon, Joshua, DO ; Catino, Joe, MD ; Puente, Ivan, MD ; Habib, Fahim, MD ; Zucker, Lloyd, MD ; Bukur, Marko, MD</creatorcontrib><description>Abstract Background In an expanding elderly population, traumatic brain injury (TBI) remains a significant cause of death and disability. Guidelines for management of TBI, according to the Brain Trauma Foundation (BTF), include intracranial pressure (ICP) monitoring. Whether ICP monitoring contributes to outcomes in the elderly patients with TBI has not been explored. Methods This is a retrospective study extracted from the National Trauma Database 2007–2008 research datasets. Patients were included if aged >55 y and they met BTF indications for ICP monitoring. Patients that had nonsurvivable injuries (any body region, abbreviated injury score = 6), were dead on arrival, had withdrawal of care, or length of stay <48 h were excluded. Outcomes were then stratified based on ICP monitoring. The primary outcomes were inhospital mortality and favorable discharge. Logistic regression was used to analyze the effect of ICP monitoring on outcomes. Results A total of 4437 patients were included with 11.2% having an ICP monitor placed. Patients requiring an ICP monitor were younger overall, more likely to present hypertensive, had higher injury severity, and more likely to require operative intervention. Median initial Glasgow coma scale (3) was similar between groups. Of those patients with ICP monitoring, overall mortality was significantly higher, and they were less likely to have favorable discharge status. Craniotomy itself was not associated with increased mortality ( P = 0.450). Conclusions Our findings suggest that the use of ICP monitoring according to BTF guidelines in elderly TBI patients does not provide outcomes superior to treatment without monitoring. The ideal group to benefit from ICP monitor placement remains to be elucidated.</description><identifier>ISSN: 0022-4804</identifier><identifier>EISSN: 1095-8673</identifier><identifier>DOI: 10.1016/j.jss.2015.03.092</identifier><identifier>PMID: 25972315</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Aged ; Aged, 80 and over ; Brain Injuries - mortality ; Brain Injuries - physiopathology ; Elderly ; Female ; Humans ; Intracranial Pressure ; Intracranial pressure monitoring ; Male ; Middle Aged ; Monitoring, Physiologic - mortality ; Monitoring, Physiologic - utilization ; Mortality ; Outcomes ; Retrospective Studies ; Surgery ; Traumatic brain injury ; United States - epidemiology</subject><ispartof>The Journal of surgical research, 2015-10, Vol.198 (2), p.482-488</ispartof><rights>Elsevier Inc.</rights><rights>2015 Elsevier Inc.</rights><rights>Copyright © 2015 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c478t-ae440f943c569b53e69e87795a0d2c37808f26764b2fb2977192aabc8ad637773</citedby><cites>FETCH-LOGICAL-c478t-ae440f943c569b53e69e87795a0d2c37808f26764b2fb2977192aabc8ad637773</cites><orcidid>0000-0002-6572-9316 ; 0000-0002-6018-4812 ; 0000-0003-2794-2092</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0022480415003571$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25972315$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Dang, Quoc, DO</creatorcontrib><creatorcontrib>Simon, Joshua, DO</creatorcontrib><creatorcontrib>Catino, Joe, MD</creatorcontrib><creatorcontrib>Puente, Ivan, MD</creatorcontrib><creatorcontrib>Habib, Fahim, MD</creatorcontrib><creatorcontrib>Zucker, Lloyd, MD</creatorcontrib><creatorcontrib>Bukur, Marko, MD</creatorcontrib><title>More fateful than fruitful? Intracranial pressure monitoring in elderly patients with traumatic brain injury is associated with worse outcomes</title><title>The Journal of surgical research</title><addtitle>J Surg Res</addtitle><description>Abstract Background In an expanding elderly population, traumatic brain injury (TBI) remains a significant cause of death and disability. Guidelines for management of TBI, according to the Brain Trauma Foundation (BTF), include intracranial pressure (ICP) monitoring. Whether ICP monitoring contributes to outcomes in the elderly patients with TBI has not been explored. Methods This is a retrospective study extracted from the National Trauma Database 2007–2008 research datasets. Patients were included if aged >55 y and they met BTF indications for ICP monitoring. Patients that had nonsurvivable injuries (any body region, abbreviated injury score = 6), were dead on arrival, had withdrawal of care, or length of stay <48 h were excluded. Outcomes were then stratified based on ICP monitoring. The primary outcomes were inhospital mortality and favorable discharge. Logistic regression was used to analyze the effect of ICP monitoring on outcomes. Results A total of 4437 patients were included with 11.2% having an ICP monitor placed. Patients requiring an ICP monitor were younger overall, more likely to present hypertensive, had higher injury severity, and more likely to require operative intervention. Median initial Glasgow coma scale (3) was similar between groups. Of those patients with ICP monitoring, overall mortality was significantly higher, and they were less likely to have favorable discharge status. Craniotomy itself was not associated with increased mortality ( P = 0.450). Conclusions Our findings suggest that the use of ICP monitoring according to BTF guidelines in elderly TBI patients does not provide outcomes superior to treatment without monitoring. The ideal group to benefit from ICP monitor placement remains to be elucidated.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Brain Injuries - mortality</subject><subject>Brain Injuries - physiopathology</subject><subject>Elderly</subject><subject>Female</subject><subject>Humans</subject><subject>Intracranial Pressure</subject><subject>Intracranial pressure monitoring</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Monitoring, Physiologic - mortality</subject><subject>Monitoring, Physiologic - utilization</subject><subject>Mortality</subject><subject>Outcomes</subject><subject>Retrospective Studies</subject><subject>Surgery</subject><subject>Traumatic brain injury</subject><subject>United States - epidemiology</subject><issn>0022-4804</issn><issn>1095-8673</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9ks1u1TAQhS0EoreFB2CDvGST4J8kToQEQhWFSkUsgLXlOBPqkNgXj011X4Jnxle3sGDByhrrOzM6c4aQZ5zVnPHu5VIviLVgvK2ZrNkgHpAdZ0Nb9Z2SD8mOMSGqpmfNGTlHXFipByUfkzPRDkpI3u7Ir48hAp1NgjmvNN0aT-eYXSrVG3rtUzQ2Gu_MSvcREHOBt-BdCtH5b9R5CusEcT3QvUkOfEJ659ItLbq8lR9Lx2gK5fyS44E6pAYxWFfmTSfyLkQEGnKyYQN8Qh7NZkV4ev9ekK9X775cfqhuPr2_vnx7U9lG9aky0DRsHhpp224YWwndAL1SQ2vYJKxUPetn0amuGcU8Fs-KD8KY0fZm6qRSSl6QF6e--xh-ZMCkN4cW1tV4CBk1V2xQvGWtKCg_oTYGxAiz3ke3mXjQnOljDHrRJQZ9jEEzqUsMRfP8vn0eN5j-Kv7svQCvTgAUkz8dRI22rM_C5CLYpKfg_tv-9T9quzrvrFm_wwFwCTn6sj3NNQrN9OfjHRzPoBhislVc_gYEI7BP</recordid><startdate>20151001</startdate><enddate>20151001</enddate><creator>Dang, Quoc, DO</creator><creator>Simon, Joshua, DO</creator><creator>Catino, Joe, MD</creator><creator>Puente, Ivan, MD</creator><creator>Habib, Fahim, MD</creator><creator>Zucker, Lloyd, MD</creator><creator>Bukur, Marko, MD</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-6572-9316</orcidid><orcidid>https://orcid.org/0000-0002-6018-4812</orcidid><orcidid>https://orcid.org/0000-0003-2794-2092</orcidid></search><sort><creationdate>20151001</creationdate><title>More fateful than fruitful? Intracranial pressure monitoring in elderly patients with traumatic brain injury is associated with worse outcomes</title><author>Dang, Quoc, DO ; Simon, Joshua, DO ; Catino, Joe, MD ; Puente, Ivan, MD ; Habib, Fahim, MD ; Zucker, Lloyd, MD ; Bukur, Marko, MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c478t-ae440f943c569b53e69e87795a0d2c37808f26764b2fb2977192aabc8ad637773</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Brain Injuries - mortality</topic><topic>Brain Injuries - physiopathology</topic><topic>Elderly</topic><topic>Female</topic><topic>Humans</topic><topic>Intracranial Pressure</topic><topic>Intracranial pressure monitoring</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Monitoring, Physiologic - mortality</topic><topic>Monitoring, Physiologic - utilization</topic><topic>Mortality</topic><topic>Outcomes</topic><topic>Retrospective Studies</topic><topic>Surgery</topic><topic>Traumatic brain injury</topic><topic>United States - epidemiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Dang, Quoc, DO</creatorcontrib><creatorcontrib>Simon, Joshua, DO</creatorcontrib><creatorcontrib>Catino, Joe, MD</creatorcontrib><creatorcontrib>Puente, Ivan, MD</creatorcontrib><creatorcontrib>Habib, Fahim, MD</creatorcontrib><creatorcontrib>Zucker, Lloyd, MD</creatorcontrib><creatorcontrib>Bukur, Marko, MD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The Journal of surgical research</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Dang, Quoc, DO</au><au>Simon, Joshua, DO</au><au>Catino, Joe, MD</au><au>Puente, Ivan, MD</au><au>Habib, Fahim, MD</au><au>Zucker, Lloyd, MD</au><au>Bukur, Marko, MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>More fateful than fruitful? Intracranial pressure monitoring in elderly patients with traumatic brain injury is associated with worse outcomes</atitle><jtitle>The Journal of surgical research</jtitle><addtitle>J Surg Res</addtitle><date>2015-10-01</date><risdate>2015</risdate><volume>198</volume><issue>2</issue><spage>482</spage><epage>488</epage><pages>482-488</pages><issn>0022-4804</issn><eissn>1095-8673</eissn><abstract>Abstract Background In an expanding elderly population, traumatic brain injury (TBI) remains a significant cause of death and disability. Guidelines for management of TBI, according to the Brain Trauma Foundation (BTF), include intracranial pressure (ICP) monitoring. Whether ICP monitoring contributes to outcomes in the elderly patients with TBI has not been explored. Methods This is a retrospective study extracted from the National Trauma Database 2007–2008 research datasets. Patients were included if aged >55 y and they met BTF indications for ICP monitoring. Patients that had nonsurvivable injuries (any body region, abbreviated injury score = 6), were dead on arrival, had withdrawal of care, or length of stay <48 h were excluded. Outcomes were then stratified based on ICP monitoring. The primary outcomes were inhospital mortality and favorable discharge. Logistic regression was used to analyze the effect of ICP monitoring on outcomes. Results A total of 4437 patients were included with 11.2% having an ICP monitor placed. Patients requiring an ICP monitor were younger overall, more likely to present hypertensive, had higher injury severity, and more likely to require operative intervention. Median initial Glasgow coma scale (3) was similar between groups. Of those patients with ICP monitoring, overall mortality was significantly higher, and they were less likely to have favorable discharge status. Craniotomy itself was not associated with increased mortality ( P = 0.450). Conclusions Our findings suggest that the use of ICP monitoring according to BTF guidelines in elderly TBI patients does not provide outcomes superior to treatment without monitoring. The ideal group to benefit from ICP monitor placement remains to be elucidated.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>25972315</pmid><doi>10.1016/j.jss.2015.03.092</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0002-6572-9316</orcidid><orcidid>https://orcid.org/0000-0002-6018-4812</orcidid><orcidid>https://orcid.org/0000-0003-2794-2092</orcidid></addata></record> |
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| subjects | Aged Aged, 80 and over Brain Injuries - mortality Brain Injuries - physiopathology Elderly Female Humans Intracranial Pressure Intracranial pressure monitoring Male Middle Aged Monitoring, Physiologic - mortality Monitoring, Physiologic - utilization Mortality Outcomes Retrospective Studies Surgery Traumatic brain injury United States - epidemiology |
| title | More fateful than fruitful? Intracranial pressure monitoring in elderly patients with traumatic brain injury is associated with worse outcomes |
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