Factors associated with receipt of intracranial pressure monitoring in older adults with traumatic brain injury.

Autor:	Ghneim M; Department of Trauma, R Adams Cowley Shock Trauma Center, Baltimore, Maryland, USA., Albrecht J; Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA., Brasel K; Department of Surgery, Oregon Health & Science University, Portland, Oregon, USA., Knight A; Department of Surgery, University of California San Francisco, San Francisco, California, USA., Liveris A; Department of Trauma, R Adams Cowley Shock Trauma Center, Baltimore, Maryland, USA.; Department of Surgery, Albert Einstein School, Bronx, New York, USA., Watras J; Department of Surgery, Inova Fairfax Medical Campus, Falls Church, Virginia, USA., Michetti CP; Department of Surgery, Inova Fairfax Hospital, Falls Church, Virginia, USA., Haan J; Department of Trauma Services, Ascension Via Christi, Wichita, Kansas, USA., Lightwine K; Department of Trauma Services, Ascension Via Christi, Wichita, Kansas, USA., Winfield RD; University of Kansas Medical Center, Kansas City, Kansas, USA., Adams SD; Department of Surgery, McGovern Medical School, Houston, Texas, USA., Podbielski J; Department of Surgery, McGovern Medical School, Houston, Texas, USA., Armen S; Departments of Surgery and Neurosurgery, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, USA., Zacko JC; Departments of Surgery and Neurosurgery, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, USA., Nasrallah FS; Trauma Service, Scripps Memorial Hospital La Jolla, La Jolla, California, USA., Schaffer KB; Trauma Service, Scripps Memorial Hospital La Jolla, La Jolla, California, USA., Dunn JA; Trauma and Acute Care Surgery, Medical Center of the Rockies, Loveland, Colorado, USA., Smoot B; Trauma and Acute Care Surgery, Medical Center of the Rockies, Loveland, Colorado, USA., Schroeppel TJ; Trauma and Acute Care Surgery, University of Colorado Health - South, Colorado Springs, Colorado, USA., Stillman Z; UCHealth Memorial Hospital Central, Colorado Springs, Colorado, USA., Cooper Z; Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA., Stein DM; Department of Surgery, University of California, San Francisco, CA, USA.
Jazyk:	angličtina
Zdroj:	Trauma surgery & acute care open [Trauma Surg Acute Care Open] 2021 Jul 23; Vol. 6 (1), pp. e000733. Date of Electronic Publication: 2021 Jul 23 (Print Publication: 2021).
DOI:	10.1136/tsaco-2021-000733
Abstrakt:	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. Competing Interests: Competing interests: JA’s institution has received research funding from the American Sleep Medicine Foundation, Merck, and ResMed. The following authors are part of the Trauma Surgery & Acute Care Open editorial team: associate editors: KB, Martin Croce, and Rosemary Kozar; editorial advisory board: ZC; editorial board reviewers: TJS, Ajai K Malhotra, David Livingston, Bellal Joseph, DMS, and Krista Kaups. (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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