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Comparative effecti...
Comparative effectiveness of intracranial hypertension management guided by ventricular versus intraparenchymal pressure monitoring : a CENTER-TBI study
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Volovici, Victor (author)
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Pisică, Dana (author)
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Gravesteijn, Benjamin Y. (author)
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Dirven, Clemens M. F. (author)
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Steyerberg, Ewout W. (author)
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Ercole, Ari (author)
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Stocchetti, Nino (author)
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- Nelson, David (author)
- Karolinska Institutet
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Menon, David K. (author)
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Citerio, Giuseppe (author)
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van der Jagt, Mathieu (author)
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Maas, Andrew I. R. (author)
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Haitsma, Iain K. (author)
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Lingsma, Hester F. (author)
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- Brorsson, Camilla (contributor)
- Umeå universitet,Institutionen för kirurgisk och perioperativ vetenskap,CENTER-TBI
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- Koskinen, Lars-Owe, Professor, 1955- (contributor)
- Umeå universitet,Neurovetenskaper,CENTER-TBI
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- Sundström, Nina (contributor)
- Umeå universitet,Institutionen för strålningsvetenskaper,CENTER-TBI
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(creator_code:org_t)
- 2022-06-01
- 2022
- English.
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In: Acta Neurochirurgica. - : Springer. - 0001-6268 .- 0942-0940. ; 164:7, s. 1693-1705
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https://umu.diva-por... (primary) (Raw object)
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Abstract
Subject headings
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- 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.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Anestesi och intensivvård (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Anesthesiology and Intensive Care (hsv//eng)
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Neurologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Neurology (hsv//eng)
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kirurgi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Surgery (hsv//eng)
Keyword
- CENTER-TBI
- EVD
- External ventricular devices
- ICP
- Intracranial hypertension
- Intracranial pressure monitoring
- Intraparenchymal monitors
- Severe TBI
- Traumatic brain injury
Publication and Content Type
- ref (subject category)
- art (subject category)
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- By the author/editor
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Volovici, Victor
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Pisică, Dana
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Gravesteijn, Ben ...
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Dirven, Clemens ...
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Steyerberg, Ewou ...
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Ercole, Ari
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show more...
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Stocchetti, Nino
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Nelson, David
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Menon, David K.
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Citerio, Giusepp ...
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van der Jagt, Ma ...
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Maas, Andrew I. ...
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Haitsma, Iain K.
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Lingsma, Hester ...
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Brorsson, Camill ...
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Koskinen, Lars-O ...
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Sundström, Nina
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- About the subject
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Clinical Medicin ...
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and Anesthesiology a ...
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Clinical Medicin ...
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and Neurology
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Clinical Medicin ...
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and Surgery
- Articles in the publication
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Acta Neurochirur ...
- By the university
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Umeå University
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Karolinska Institutet