The effect of intracranial pressure monitoring on severe traumatic brain injury patients who undergo subdural hematoma evacuation

Abstract

Abstract

Intracranial pressure (ICP) monitoring is frequently employed for patients with severe traumatic brain injury. The effect of intracranial pressure monitoring on patient outcomes has been studied little, and results often fail to account for confounding variables. We sought to focus on the impact of ICP monitoring on patients with severe traumatic brain injury and subdural hematoma (SDH) that underwent surgical intervention. Using the National Trauma Data Bank, we identified patients between 2021 and 2024 who had SDH and a presenting Glasgow Coma Score (GCS) of 3-8 who underwent an SDH evacuation. Of the patients whose ICP monitoring status was known, we compared the in-hospital mortality rate and length of stay (LOS) of patients who had ICP monitoring and those who did not. 3932 patients met the inclusion criteria, with 1481 patients undergoing ICP monitoring and 2451 not undergoing ICP monitoring. After propensity score matching to control for confounding variables, 1271 patients from each cohort were selected for further analysis. In-hospital mortality rate of the patients with monitoring did not show a significant difference from the cohort without ICP monitoring, in either matched (41.6% vs. 41.9%, p = 0.9) or without matching scenario (40.2% vs. 42.6%, p = 0.15). However, patients with ICP monitoring showed a longer hospital stay compared to the cohort without ICP monitoring (median 19 days vs. 13 days, p < 0.001). While ICP monitoring is recommended in brain injury treatment guidelines, it did not show a significant impact on the in-hospital mortality rate of patients with SDH and GCS 3-8 who had undergone SDH evacuation. Patients with ICP monitoring had significantly longer LOS and a higher rate of complications, including ventilator-associated pneumonia, deep venous thrombosis, and acute respiratory distress syndrome. Additional study is needed to determine if ICP monitoring improves outcomes in various populations of traumatic brain injury patients. Clinical trial number: not applicable.