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Monitoring of intracranial pressure in patients with severe traumatic brain injury: an Austrian prospective multicenter study

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Abstract

Objective

The goals of this study were to elucidate reasons why patients did or did not receive intracranial pressure (ICP) monitoring and to describe factors influencing hospital mortality after severe traumatic brain injury (TBI).

Design

Prospective multicenter cohort study.

Patients and participants

88,274 patients consecutively admitted to 32 medical, surgical and mixed Austrian ICUs between 1998 and 2004.

Interventions

None.

Measurements and results

1,856 patients (2.1% of all ICU admissions) exhibited severe TBI (GCS < 9); of these, 1,031 (56%) had ICP monitoring. The “worst” and the “best” cases were both less likely to receive ICP monitoring. Younger patients, female patients, and patients with isolated TBI were more likely to receive ICP monitoring. Compared with large centers ICP was monitored more frequently [odds ratio (OR) 3.09, CI 2.42–3.94] in medium-sized centers. The 20% of patients with the highest likelihood to receive ICP monitoring were monitored in 91% of cases, and had the lowest hospital mortality (31%, OR 0.78, CI 0.37–1.64). Multivariate analysis revealed that severity of illness, TBI severity, isolated TBI, and the number of cases treated per year were associated with hospital outcome. Compared with the large centers, ORs for hospital mortality were 1.85 (CI 1.42–2.40) for patients from medium-sized centers and 1.91 (CI 1.24–2.93) for patients from small centers.

Conclusions

ICP monitoring may possibly have some beneficial effects, but this needs further evaluation. Patients with severe TBI should be admitted to experienced centers with high patient volumes since this might improve hospital mortality rates.

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Acknowledgements

We thank the members of the ASDI study group and their respective study coordinators in each ICU: H. Artmann, A. Bacher, T. Bauer, G. Derzsenyi, K. Dörre, G. Edelmann, I. Eder, F. Ernst, F. Firlinger, S. Fitzal, H. Fresacher, A. Geppert, G. Halvax, M. Hiesmayr, K. Hudabiunigg, W. Hufnagl, T, Janous, S. Klaunzer, W. Klimscha, G. Koinig, D. Krucher, K. Lampl, D. Linemayr, S. Lister, G. Locker, C. Madl, H. Malle, W. Mauritz, G. Naderer, U. Ortler, B. Pichler, W. Regal, G. Sagmüller, I. Schindler, H. Schneller, F. Schwameis, E. Seyfried, G. Sprinzl, F. Tichelmann, H. Trimmel, A. Valentin, H. Vesely, F. Wimmer, P. Zanon, and M. Zeilinger. This study was supported, in part, by a grant from AUVA (Allgemeine Unfallversicherungsanstalt).

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Authors and Affiliations

  1. Department of Anaesthesia and Critical Care Medicine, Trauma Hospital “Lorenz Boehler”, Donaueschingenstrasse 13, 1200, Vienna, Austria

    Walter Mauritz

  2. Department of Anaesthesia and Critical Care Medicine, Trauma Hospital “Meidling”, Kundratstrasse 37, 1120, Vienna, Austria

    Heinz Steltzer

  3. Department of Medical Statistics, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria

    Peter Bauer & Lorenz Dolanski-Aghamanoukjan

  4. Department of Anaesthesia and General Intensive Care Medicine, Medical University of Vienna, Waehringer Guertel 18–20, 1090, Vienna, Austria

    Philipp Metnitz

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  1. Walter Mauritz
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  2. Heinz Steltzer
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  3. Peter Bauer
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  4. Lorenz Dolanski-Aghamanoukjan
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  5. Philipp Metnitz
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Corresponding author

Correspondence to Walter Mauritz.

Additional information

This article is discussed in the editorial available at: http://dx.doi.org/10.1007/s00134-008-1080-1

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Mauritz, W., Steltzer, H., Bauer, P. et al. Monitoring of intracranial pressure in patients with severe traumatic brain injury: an Austrian prospective multicenter study. Intensive Care Med 34, 1208–1215 (2008). https://doi.org/10.1007/s00134-008-1079-7

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  • DOI: https://doi.org/10.1007/s00134-008-1079-7

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