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

Mira Ghneim; Jennifer Albrecht; Karen Brasel; Ariel Knight; Anna Liveris; Jill Watras; Christopher P Michetti; James Haan; Kelly Lightwine; Robert D Winfield; Sasha D Adams; Jeanette Podbielski; Scott Armen; J Christopher Zacko; Fady S Nasrallah; Kathryn B Schaffer; Julie A Dunn; Brittany Smoot; Thomas J Schroeppel; Zachery Stillman; Zara Cooper; Deborah M Stein; Geri-TBI Study

doi:10.1136/tsaco-2021-000733

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

Trauma Surg Acute Care Open. 2021 Jul 23;6(1):e000733. doi: 10.1136/tsaco-2021-000733. eCollection 2021.

Authors

Mira Ghneim¹, Jennifer Albrecht², Karen Brasel³, Ariel Knight⁴, Anna Liveris^{1

5}, Jill Watras⁶, Christopher P Michetti⁷, James Haan⁸, Kelly Lightwine⁸, Robert D Winfield⁹, Sasha D Adams¹⁰, Jeanette Podbielski¹⁰, Scott Armen¹¹, J Christopher Zacko¹¹, Fady S Nasrallah¹², Kathryn B Schaffer¹², Julie A Dunn¹³, Brittany Smoot¹³, Thomas J Schroeppel¹⁴, Zachery Stillman¹⁵, Zara Cooper¹⁶, Deborah M Stein¹⁷; Geri-TBI Study

Collaborators

Geri-TBI Study:
Charles Adams, Stephanie Lueckel, Jason Murry, Cindy Hsu, Umer F Bhatti, Matthew E Lissauer, Marc LaFonte, Kaveh Najafi, Karen Lewandowski, Kaushik Mukherjee, Kristelle J Imperio-Lagabon, Niels D Martin, Kathleen Hirsch, Cherisse Berry, Derek Freitas, Daniel Cullinane, Roshini Ramawani, Michael Truitt, Chris Pearcy, Habiba Hashimi, Krista Kaups, Jeffry Claridge, Husayn Ladhani, Jennifer L Hartwell, Jessica Ballou, Martin Croce, Stephanie Markle, Sally Osserwaarde, Joseph Posluszny, Benjamin Stocker, Tjasa Hranjec, Rachele Solomon, Lucy Martinek, Alok Gupta, Daniel J Grabo, Uzer Khan, Danielle Tatum, Tomas Jacome, Jonathan Gates, Alisha Jawani, Allison E Berndtson, Terry G Curry, Miklosh Bala, Linda A Dultz, Natasha N Houshmand, Paola Pieri, Martin D Zielinski, Joy D Hughes, Jennifer Hartwell, Ajai K Malhotra, Tim Lee, Patrizio Petrone, D'andrea Joseph, Gary T Marshall, Matthew M Carrick, Abhijit Pathak, Andrea Van Zandt, Nina Glass, David Livingston, Shea Gregg, Travis Webb, Byron Drumheller, Rosemary Kozar, Robert Barraco, Bellal Joseph

Affiliations

¹ Department of Trauma, R Adams Cowley Shock Trauma Center, Baltimore, Maryland, USA.
² Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA.
³ Department of Surgery, Oregon Health & Science University, Portland, Oregon, USA.
⁴ Department of Surgery, University of California San Francisco, San Francisco, California, USA.
⁵ Department of Surgery, Albert Einstein School, Bronx, New York, USA.
⁶ Department of Surgery, Inova Fairfax Medical Campus, Falls Church, Virginia, USA.
⁷ Department of Surgery, Inova Fairfax Hospital, Falls Church, Virginia, USA.
⁸ Department of Trauma Services, Ascension Via Christi, Wichita, Kansas, USA.
⁹ University of Kansas Medical Center, Kansas City, Kansas, USA.
¹⁰ Department of Surgery, McGovern Medical School, Houston, Texas, USA.
¹¹ Departments of Surgery and Neurosurgery, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, USA.
¹² Trauma Service, Scripps Memorial Hospital La Jolla, La Jolla, California, USA.
¹³ Trauma and Acute Care Surgery, Medical Center of the Rockies, Loveland, Colorado, USA.
¹⁴ Trauma and Acute Care Surgery, University of Colorado Health - South, Colorado Springs, Colorado, USA.
¹⁵ UCHealth Memorial Hospital Central, Colorado Springs, Colorado, USA.
¹⁶ Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA.
¹⁷ Department of Surgery, University of California, San Francisco, CA, USA.

Abstract

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.

Keywords: brain injuries; geriatrics; intracranial pressure; traumatic.

Abstract

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