Perceived Utility of Intracranial Pressure Monitoring in Traumatic Brain Injury: A Seattle International Brain Injury Consensus Conference Consensus-Based Analysis and Recommendations.

Humans Intracranial Pressure / physiology Brain Injuries Brain Injuries, Traumatic / diagnosis Intracranial Hypertension / diagnosis Glasgow Coma Scale Monitoring, Physiologic / methods

Journal

Neurosurgery
ISSN: 1524-4040
Titre abrégé: Neurosurgery
Pays: United States
ID NLM: 7802914

Informations de publication

Date de publication:
01 08 2023
Historique:
received: 15 10 2022
accepted: 02 01 2023
pmc-release: 12 05 2024
medline: 19 7 2023
pubmed: 12 5 2023
entrez: 12 5 2023
Statut: ppublish

Résumé

Intracranial pressure (ICP) monitoring is widely practiced, but the indications are incompletely developed, and guidelines are poorly followed. To study the monitoring practices of an established expert panel (the clinical working group from the Seattle International Brain Injury Consensus Conference effort) to examine the match between monitoring guidelines and their clinical decision-making and offer guidance for clinicians considering monitor insertion. We polled the 42 Seattle International Brain Injury Consensus Conference panel members' ICP monitoring decisions for virtual patients, using matrices of presenting signs (Glasgow Coma Scale [GCS] total or GCS motor, pupillary examination, and computed tomography diagnosis). Monitor insertion decisions were yes, no, or unsure (traffic light approach). We analyzed their responses for weighting of the presenting signs in decision-making using univariate regression. Heatmaps constructed from the choices of 41 panel members revealed wider ICP monitor use than predicted by guidelines. Clinical examination (GCS) was by far the most important characteristic and differed from guidelines in being nonlinear. The modified Marshall computed tomography classification was second and pupils third. We constructed a heatmap and listed the main clinical determinants representing 80% ICP monitor insertion consensus for our recommendations. Candidacy for ICP monitoring exceeds published indicators for monitor insertion, suggesting the clinical perception that the value of ICP data is greater than simply detecting and monitoring severe intracranial hypertension. Monitor insertion heatmaps are offered as potential guidance for ICP monitor insertion and to stimulate research into what actually drives monitor insertion in unconstrained, real-world conditions.

Sections du résumé

BACKGROUND
Intracranial pressure (ICP) monitoring is widely practiced, but the indications are incompletely developed, and guidelines are poorly followed.
OBJECTIVE
To study the monitoring practices of an established expert panel (the clinical working group from the Seattle International Brain Injury Consensus Conference effort) to examine the match between monitoring guidelines and their clinical decision-making and offer guidance for clinicians considering monitor insertion.
METHODS
We polled the 42 Seattle International Brain Injury Consensus Conference panel members' ICP monitoring decisions for virtual patients, using matrices of presenting signs (Glasgow Coma Scale [GCS] total or GCS motor, pupillary examination, and computed tomography diagnosis). Monitor insertion decisions were yes, no, or unsure (traffic light approach). We analyzed their responses for weighting of the presenting signs in decision-making using univariate regression.
RESULTS
Heatmaps constructed from the choices of 41 panel members revealed wider ICP monitor use than predicted by guidelines. Clinical examination (GCS) was by far the most important characteristic and differed from guidelines in being nonlinear. The modified Marshall computed tomography classification was second and pupils third. We constructed a heatmap and listed the main clinical determinants representing 80% ICP monitor insertion consensus for our recommendations.
CONCLUSION
Candidacy for ICP monitoring exceeds published indicators for monitor insertion, suggesting the clinical perception that the value of ICP data is greater than simply detecting and monitoring severe intracranial hypertension. Monitor insertion heatmaps are offered as potential guidance for ICP monitor insertion and to stimulate research into what actually drives monitor insertion in unconstrained, real-world conditions.

Identifiants

DOI: 10.1227/neu.0000000000002516 PMID: 37171175 PMC: PMC10319366
pubmed: 37171175
doi: 10.1227/neu.0000000000002516
pii: 00006123-202308000-00018
pmc: PMC10319366
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

399-408

Informations de copyright

Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Congress of Neurological Surgeons.

Références

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Auteurs

Randall M Chesnut (RM)

Department of Neurological Surgery, University of Washington, Seattle, Washington, USA.
Department of Orthopaedic Surgery, University of Washington, Seattle, Washington, USA.
School of Global Health, University of Washington, Seattle, Washington, USA.
Harborview Medical Center, University of Washington, Seattle, Washington, USA.
ORCID: 0000-0001-6377-3666

Sergio Aguilera (S)

Almirante Nef Naval Hospital, Valparaiso University, Viña Del Mar, Chile.
Valparaiso University, Valparaiso, Chile.

Andras Buki (A)

Department of Neurosurgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.

Eileen M Bulger (EM)

Department of Surgery, Harborview Medical Center, University of Washington, Seattle, Washington, USA.

Giuseppe Citerio (G)

School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.
Neuroscience Department, NeuroIntensive Care Unit, Fondazione IRCCS San Gerardo dei Tintori, Monza, Monza, Italy.

D Jamie Cooper (DJ)

Intensive Care Medicine, Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia.
Department of Intensive Care and Hyperbaric Medicine, The Alfred Hospital, Melbourne, VIC, Australia.

Ramon Diaz Arrastia (RD)

Department of Neurology, Penn Presbyterian Medical Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.

Michael Diringer (M)

Department of Neurology, Washington University School of Medicine, St Louis, USA.
Department of Neurology, Barnes-Jewish Hospital, St Louis, Missouri, USA.

Anthony Figaji (A)

Division of Neurosurgery and Neuroscience Institute, Groote Schuur Hospital, University of Cape Town, Observatory 7925, South Africa.

Guoyi Gao (G)

Department of Neurosurgery, Renji Hospital, Shanghai Institute of Head Trauma, Shanghai Jiaotong University School of Medicine, Shanghai, China.

Romergryko G Geocadin (RG)

Departments of Neurology, Neurological Surgery, Anesthesiology-Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.

Jamshid Ghajar (J)

Department of Neurosurgery, Stanford Neuroscience Health Center, Palo Alto, California, USA.

Odette Harris (O)

Department of Neurosurgery, Stanford University School of Medicine, Center for Academic Medicine, Stanford, California, USA.

Gregory W J Hawryluk (GWJ)

Cleveland Clinic Akron General Neurosciences Center, Fairlawn, Ohio, USA.
Uniformed Services University, Bethesda, Maryland, USA.
Brain Trauma Foundation, New York City, New York, USA.

Alan Hoffer (A)

UH Cleveland Medical Center, Cleveland, Ohio, USA.

Peter Hutchinson (P)

Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge and Cambridge Biomedical Campus, Cambridge, UK.

Mathew Joseph (M)

Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India.

Ryan Kitagawa (R)

Vivian L Smith Department of Neurosurgery, McGovern Medical School at UTHealth, Houston, Texas, USA.

Geoffrey Manley (G)

Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA.
Department of Neurosurgery, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California, USA.

Stephan Mayer (S)

Westchester Health Network, New York Medical College, Valhalla, New York, USA.

David K Menon (DK)

Division of Anaesthesia, Addenbrooke's Hospital, University of Cambridge and Addenbrooke's Hospital, Cambridge, UK.

Geert Meyfroidt (G)

Department of Intensive Care Medicine, University Hospitals Leuven and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium.

Daniel B Michael (DB)

Department of Neurosurgery, Beaumont Health, Michigan Head and Spine Institute, Oakland University William Beaumont School of Medicine, Southfield, Michigan, USA.

Mauro Oddo (M)

CHUV Medical Directorate and Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland.

David O Okonkwo (DO)

Department of Neurosurgery, University of Pittsburgh Medical Center Presbyterian, Pittsburgh, Pennsylvania, USA.

Mayur B Patel (MB)

Department of Surgery, Division of Acute Care Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.

Claudia Robertson (C)

Department of Neurosurgery, Baylor College of Medicine, One Baylor Plaza, Houston, Texas, USA.

Jeffrey V Rosenfeld (JV)

Department of Neurosurgery, Alfred Hospital, Melbourne, Australia.
Department of Surgery, Monash University, Melbourne, Australia.

Andres M Rubiano (AM)

INUB/MEDITECH Research Group, Neurosciences Institute, El Bosque University, Bogotá, Colombia.
MEDITECH Foundation, Clinical Research, Cali, Colombia.

Juain Sahuquillo (J)

Department of Neurosurgery, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona: Neurotraumatology and Neurosurgery Research Unit (UNINN), Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain.

Franco Servadei (F)

Department of Biomedical Sciences, Humanitas University and IRCCS Humanitas Research Hospital, Milano, Italy.

Lori Shutter (L)

Department of Critical Care Medicine, Neurology and Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.

Deborah M Stein (DM)

University of Maryland School of Medicine, Adult Critical Care Services, University of Maryland Medical Center, Baltimore, Maryland, USA.

Nino Stocchetti (N)

Department of Physiopathology and Transplantation, Milan University, Milan, Italy.
Neuroscience Intensive Care Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy.

Fabio Silvio Taccone (FS)

Department of Intensive Care, Hôpital Universitaire de Bruxelles (HUB), Université Libre de Bruxelles (ULB), Brussels, Belgium.

Shelly D Timmons (SD)

Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA.

Eve C Tsai (EC)

Suruchi Bhargava Chair in Spinal Cord and Brain Regeneration Research, The Ottawa Hospital, Department of Surgery, Division of Neurosurgery, University of Ottawa, Civic Campus, Ottawa, Ontario, Canada.

Jamie S Ullman (JS)

Department of Neurosurgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, North Shore University Hospital, Manhasset, New York, USA.

Walter Videtta (W)

Intensive Care, Posadas Hospital, Buenos Aires, Argentina.

David W Wright (DW)

Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.

Christopher Zammit (C)

Department of Emergency Medicine, University of Rochester Medical Center, Rochester, New York, USA.

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