Q. N. Dang2, J. Simon2, J. Catino1,3, I. Puente1,3, F. Habib1,3, L. Zucker1, M. Bukur1,3 1Delray Regional Medical Center,Trauma And Surgical Critical Care,Delray Beach, FL, USA 2Larkin Community Hospital,Surgery,South Miami, FL, USA 3Broward General Hospital,Trauma And Surgical Critical Care,Fort Lauderdale, FL, USA
Introduction: 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 or not 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 age > 55 and they met BTF indications for ICP monitoring. Patients that had non-survivable injuries (any body AIS = 6), were dead on arrival, had withdrawal of care, or LOS < 48 hours were excluded. Outcomes were then stratified based upon ICP monitoring. The primary outcomes were in-hospital mortality as well as favorable discharge (to home or rehab facility). Logistic regression was used to analyze the effect of ICP monitoring on outcomes.
Results: A total of 4437 patients were included with 11.1% 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 GCS (3) and Head AIS (4) were similar between groups. Of those patients with ICP monitoring, overall mortality was significantly higher (table) and they were less likely to have favorable discharge status. Craniotomy itself was not associated with increased mortality (p = 0.450)
Conclusion: 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.
