Comparative Effectiveness of Intracranial Pressure Monitoring vs No Monitoring in Severe Penetrating Brain Injury Management
Authors' conclusion
In this comparative effectiveness research study, PBI management guided by ICP monitoring was associated with decreased mortality and increased ICU LOS, challenging the notion of universally poor outcomes after civilian PBI.
Study context
- Population
- Patients aged 16–60 years with severe penetrating brain injury (PBI) (Glasgow Coma Scale (GCS) <9 on arrival and at 24 h, intensive care unit (ICU) length of stay (LOS) >2 days), US TQIP, 2017–2019; bilaterally fixed pupils excluded466 propensity score (PS)-matched
- Participants
- 596 patients
- Exposure
- Intracranial pressure (ICP) monitoring vs no monitoring
- ICP monitoringn = 233
- No ICP monitoringn = 233reference
- Outcome
- Mortality
Methodological detailsretrospective registry cohort, 1:1 propensity-score matched, PS-weighted analysis, National Trauma Data Bank TQIP registry
- Retrospective registry cohort
- 1:1 propensity-score matched
- PS-weighted analysis
- National Trauma Data Bank TQIP registry
Main finding
Mortality (PS-matched)
OR for survival
1.54
95% CI 1.05–2.25
P = 0.03
Events by group
ICP monitoring vs No ICP monitoring
OR for survival 1.54 (95% CI 1.05–2.25); P = 0.03
As reported in the abstract
Observational data: associations, not effects.
Further findings
| Outcome | OR for survival (95% CI) | P value | |
|---|---|---|---|
| Survival (PS-weighted analysis, all patients) | 1.40 (1.10–1.78) | P = 0.005 | |
| 0.512OR for survival (log scale) |
ICU LOS
P < 0.001
- Survival (PS-weighted analysis, all patients): 596 patients
Favorable discharge disposition
- No difference observed
Original publication
Comparative Effectiveness of Intracranial Pressure Monitoring vs No Monitoring in Severe Penetrating Brain Injury Management. JAMA Netw Open. Published 1 March 2023. doi:10.
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