Trauma Surgery & Acute Care Open (Aug 2021)
Factors associated with receipt of intracranial pressure monitoring in older adults with traumatic brain injury
- Deborah M Stein,
- Julie A Dunn,
- Thomas J Schroeppel,
- Jeanette Podbielski,
- Bellal Joseph,
- Jason Murry,
- Christopher P Michetti,
- Karen Brasel,
- Krista Kaups,
- Karen Lewandowski,
- Kaushik Mukherjee,
- Fady S Nasrallah,
- Kathryn B Schaffer,
- Paola Pieri,
- James Haan,
- Kelly Lightwine,
- Rachele Solomon,
- Robert D Winfield,
- Ajai K. Malhotra,
- Charles Adams,
- D'Andrea Joseph,
- Miklosh Bala,
- Rosemary Kozar,
- Tim Lee,
- Stephanie Lueckel,
- Zara Cooper,
- Alok Gupta,
- Jennifer Albrecht,
- Niels D. Martin,
- Patrizio Petrone,
- Jonathan Gates,
- Mira Ghneim,
- Ariel Knight,
- Anna Liveris,
- Jill Watras,
- Scott Armen,
- J Christopher Zacko,
- Brittany Smoot,
- Zachery Stillman,
- Cindy Hsu,
- Umer F. Bhatti,
- Matthew E Lissauer,
- Marc LaFonte,
- Kaveh Najafi,
- Kristelle J. Imperio-Lagabon,
- Kathleen Hirsch,
- Cherisse Berry,
- Derek Freitas,
- Daniel Cullinane,
- Roshini Ramawani,
- Michael Truitt,
- Chris Pearcy,
- Habiba Hashimi,
- Jeffry Claridge,
- Husayn Ladhani,
- Jennifer L. Hartwell,
- Jessica Ballou,
- Martin Croce,
- Stephanie Markle,
- Sally Osserwaarde,
- Joseph Posluszny,
- Benjamin Stocker,
- Tjasa Hranjec,
- Lucy Martinek,
- Daniel J. Grabo,
- Uzer Khan,
- Danielle Tatum,
- Tomas Jacome,
- Alisha Jawani,
- Allison E. Berndtson,
- Terry G. Curry,
- Linda A. Dultz,
- Natasha N. Houshmand,
- Martin D Zielinski,
- Joy D. Hughes,
- Jennifer Hartwell,
- Gary T. Marshall,
- Matthew M. Carrick,
- Abhijit Pathak,
- Andrea Van Zandt,
- Nina Glass,
- David Livingston,
- Shea Gregg,
- Travis Webb,
- Byron Drumheller,
- Robert Barraco
Affiliations
- Deborah M Stein
- Department of Surgery, University of California, San Francisco, CA, USA
- Julie A Dunn
- Trauma and Acute Care Surgery, Medical Center of the Rockies, Loveland, Colorado, USA
- Thomas J Schroeppel
- Trauma and Acute Care Surgery, University of Colorado Health - South, Colorado Springs, Colorado, USA
- Jeanette Podbielski
- Department of Surgery, McGovern Medical School, Houston, Texas, USA
- Bellal Joseph
- Jason Murry
- Christopher P Michetti
- Department of Surgery, Inova Fairfax Hospital, Falls Church, Virginia, USA
- Karen Brasel
- Department of Surgery, Oregon Health & Science University, Portland, Oregon, USA
- Krista Kaups
- Karen Lewandowski
- Kaushik Mukherjee
- Fady S Nasrallah
- Trauma Service, Scripps Memorial Hospital La Jolla, La Jolla, California, USA
- Kathryn B Schaffer
- Trauma Service, Scripps Memorial Hospital La Jolla, La Jolla, California, USA
- Paola Pieri
- James Haan
- Department of Trauma Services, Ascension Via Christi, Wichita, Kansas, USA
- Kelly Lightwine
- Department of Trauma Services, Ascension Via Christi, Wichita, Kansas, USA
- Rachele Solomon
- Robert D Winfield
- University of Kansas Medical Center, Kansas City, Kansas, USA
- Ajai K. Malhotra
- Charles Adams
- D'Andrea Joseph
- Miklosh Bala
- Rosemary Kozar
- Tim Lee
- Stephanie Lueckel
- Zara Cooper
- Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Alok Gupta
- Jennifer Albrecht
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Niels D. Martin
- Patrizio Petrone
- Jonathan Gates
- Mira Ghneim
- Department of Trauma, R Adams Cowley Shock Trauma Center, Baltimore, Maryland, USA
- Ariel Knight
- Department of Surgery, University of California San Francisco, San Francisco, California, USA
- Anna Liveris
- Department of Trauma, R Adams Cowley Shock Trauma Center, Baltimore, Maryland, USA
- Jill Watras
- Department of Surgery, Inova Fairfax Medical Campus, Falls Church, Virginia, USA
- Scott Armen
- Departments of Surgery and Neurosurgery, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, USA
- J Christopher Zacko
- Departments of Surgery and Neurosurgery, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, USA
- Brittany Smoot
- Trauma and Acute Care Surgery, Medical Center of the Rockies, Loveland, Colorado, USA
- Zachery Stillman
- UCHealth Memorial Hospital Central, Colorado Springs, Colorado, USA
- Cindy Hsu
- Umer F. Bhatti
- Matthew E Lissauer
- Marc LaFonte
- Kaveh Najafi
- Kristelle J. Imperio-Lagabon
- Kathleen Hirsch
- Cherisse Berry
- Derek Freitas
- Daniel Cullinane
- Roshini Ramawani
- Michael Truitt
- Chris Pearcy
- Habiba Hashimi
- Jeffry Claridge
- Husayn Ladhani
- Jennifer L. Hartwell
- Jessica Ballou
- Martin Croce
- Stephanie Markle
- Sally Osserwaarde
- Joseph Posluszny
- Benjamin Stocker
- Tjasa Hranjec
- Lucy Martinek
- Daniel J. Grabo
- Uzer Khan
- Danielle Tatum
- Tomas Jacome
- Alisha Jawani
- Allison E. Berndtson
- Terry G. Curry
- Linda A. Dultz
- Natasha N. Houshmand
- Martin D Zielinski
- Joy D. Hughes
- Jennifer Hartwell
- Gary T. Marshall
- Matthew M. Carrick
- Abhijit Pathak
- Andrea Van Zandt
- Nina Glass
- David Livingston
- Shea Gregg
- Travis Webb
- Byron Drumheller
- Robert Barraco
- DOI
- https://doi.org/10.1136/tsaco-2021-000733
- Journal volume & issue
-
Vol. 6,
no. 1
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.
