Factors associated with receipt of intracranial pressure monitoring in older adults with traumatic brain injury. Issue 1 (23rd July 2021)

• Record Type: Journal Article
• Authors: Ghneim, Mira; Albrecht, Jennifer; Brasel, Karen; Knight, Ariel; Liveris, Anna; Watras, Jill; Michetti, Christopher P; Haan, James; Lightwine, Kelly; Winfield, Robert D; Adams, Sasha D; Podbielski, Jeanette; Armen, Scott; Zacko, J Christopher; Nasrallah, Fady S; Schaffer, Kathryn B; Dunn, Julie A; Smoot, Brittany; Schroeppel, Thomas J; Stillman, Zachery; Cooper, Zara; Stein, Deborah M
• Other Names: author non-byline.; Adams Charles author non-byline.; Lueckel Stephanie author non-byline.; Murry Jason author non-byline.; Hsu Cindy author non-byline.; Bhatti Umer F. author non-byline.; Lissauer Matthew E author non-byline.; LaFonte Marc author non-byline.; Najafi Kaveh author non-byline.; Lewandowski Karen author non-byline.; Mukherjee Kaushik author non-byline.; Imperio-Lagabon Kristelle J. author non-byline.; Martin Niels D. author non-byline.; Hirsch Kathleen author non-byline.; Berry Cherisse author non-byline.; Freitas Derek author non-byline.; Cullinane Daniel author non-byline.; Ramawani Roshini author non-byline.; Truitt Michael author non-byline.; Pearcy Chris author non-byline.; Hashimi Habiba author non-byline.; Kaups Krista author non-byline.; Claridge Jeffry author non-byline.; Ladhani Husayn author non-byline.; Hartwell Jennifer L. author non-byline.; Ballou Jessica author non-byline.; Croce Martin author non-byline.; Markle Stephanie author non-byline.; Osserwaarde Sally author non-byline.; Posluszny Joseph author non-byline.; Stocker Benjamin author non-byline.; Hranjec Tjasa author non-byline.; Solomon Rachele author non-byline.; Martinek Lucy author non-byline.; Gupta Alok author non-byline.; Grabo Daniel J. author non-byline.; Khan Uzer author non-byline.; Tatum Danielle author non-byline.; Jacome Tomas author non-byline.; Gates Jonathan author non-byline.; Jawani Alisha author non-byline.; Berndtson Allison E. author non-byline.; Curry Terry G. author non-byline.; Bala Miklosh author non-byline.; Dultz Linda A. author non-byline.; Houshmand Natasha N. author non-byline.; Pieri Paola author non-byline.; Zielinski Martin D author non-byline.; Hughes Joy D. author non-byline.; Hartwell Jennifer author non-byline.; Malhotra Ajai K. author non-byline.; Lee Tim author non-byline.; Petrone Patrizio author non-byline.; Joseph D'andrea author non-byline.; Marshall Gary T. author non-byline.; Carrick Matthew M. author non-byline.; Pathak Abhijit author non-byline.; Zandt Andrea Van author non-byline.; Glass Nina author non-byline.; Livingston David author non-byline.; Gregg Shea author non-byline.; Webb Travis author non-byline.; Drumheller Byron author non-byline.; Kozar Rosemary author non-byline.; Barraco Robert author non-byline.; Joseph Bellal author non-byline.;
• Is Part Of: Trauma surgery & acute care open. Volume 6:Issue 1(2021)
• Publication Date: 2021-07-23
• Subjects: brain injuries -- traumatic -- geriatrics -- intracranial pressure; Traumatology -- Periodicals; Critical care medicine -- Periodicals; Wounds and injuries -- Periodicals; 617.1
• DOI: 10.1136/tsaco-2021-000733
• Languages: English
• ISSNs: 2397-5776

Abstract

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.