M. Goodrich1, H. Sharp2, T. Locklear2, M. Williams1, J. Stodghill1 1Carilion Clinic -Virginia Tech Carilion School of Medicine, Roanoke, VA, USA 2Carilion Clinic, Health Analytics Research, Roanoke, VA, USA
Introduction: Measuring and managing intracranial pressure (ICP) is central to the management of severe traumatic brain injuries (TBI). External ventricular drains (EVD) and/or intraparenchymal intracranial pressure (IP-ICP) monitors are often utilized. Studies evaluating the effect of monitor type on outcomes have been small, single center studies with conflicting results. We hypothesized that the type of ICP monitor used would impact ventilator/ICU/hospital length of stay (LOS) and in-hospital mortality.
Methods: National trauma registry (TQIP) data from 2011-2019 for severe TBI patients was obtained. Patients were categorized as those receiving IP-ICP monitor or EVD. Demographic, comorbidity, injury severity scores and Glasco coma scale data were collected. Negative binomial regression models utilizing propensity score weighting assessed differences in ventilator/ICU/hospital LOS by monitor type. Binary logistic regression utilizing propensity score weighting examined the association between in-hospital mortality and monitor type. Validation of propensity matching was assessed by analyzing the standardized mean difference of model covariate.
Results: Of the 46,087 patients identified, 32,677 (70.9%) underwent IP-ICP monitor, 13,410 (29.1%) underwent EVD. Ventilator/ICU/hospital LOS and in-hospital mortality were found to be significantly lower in those patients managed with IP-ICP monitors (Table 1).
Conclusion: There is a paucity of published data comparing IP-ICP monitors vs EVDs in the management of severe TBI patients. This is the largest study to date to evaluate outcomes data in relation to type of ICP monitor utilized. In the included patient population, patients with severe TBI who were managed with IP-ICP monitors had a significantly lower ventilator/ICU/hospital LOS as well as an improved in-hospital mortality compared to those patients managed with EVDs.
