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Original research
Factors associated with receipt of intracranial pressure monitoring in older adults with traumatic brain injury
  1. Mira Ghneim1,
  2. Jennifer Albrecht2,
  3. Karen Brasel3,
  4. Ariel Knight4,
  5. Anna Liveris1,5,
  6. Jill Watras6,
  7. Christopher P Michetti7,
  8. James Haan8,
  9. Kelly Lightwine8,
  10. Robert D Winfield9,
  11. Sasha D Adams10,
  12. Jeanette Podbielski10,
  13. Scott Armen11,
  14. J Christopher Zacko11,
  15. Fady S Nasrallah12,
  16. Kathryn B Schaffer12,
  17. Julie A Dunn13,
  18. Brittany Smoot13,
  19. Thomas J Schroeppel14,
  20. Zachery Stillman15,
  21. Zara Cooper16,
  22. Deborah M Stein17
  23. Geri-TBI Study Group
    1. 1Department of Trauma, R Adams Cowley Shock Trauma Center, Baltimore, Maryland, USA
    2. 2Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
    3. 3Department of Surgery, Oregon Health & Science University, Portland, Oregon, USA
    4. 4Department of Surgery, University of California San Francisco, San Francisco, California, USA
    5. 5Department of Surgery, Albert Einstein School, Bronx, New York, USA
    6. 6Department of Surgery, Inova Fairfax Medical Campus, Falls Church, Virginia, USA
    7. 7Department of Surgery, Inova Fairfax Hospital, Falls Church, Virginia, USA
    8. 8Department of Trauma Services, Ascension Via Christi, Wichita, Kansas, USA
    9. 9University of Kansas Medical Center, Kansas City, Kansas, USA
    10. 10Department of Surgery, McGovern Medical School, Houston, Texas, USA
    11. 11Departments of Surgery and Neurosurgery, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, USA
    12. 12Trauma Service, Scripps Memorial Hospital La Jolla, La Jolla, California, USA
    13. 13Trauma and Acute Care Surgery, Medical Center of the Rockies, Loveland, Colorado, USA
    14. 14Trauma and Acute Care Surgery, University of Colorado Health - South, Colorado Springs, Colorado, USA
    15. 15UCHealth Memorial Hospital Central, Colorado Springs, Colorado, USA
    16. 16Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, USA
    17. 17Department of Surgery, University of California, San Francisco, CA, USA
    1. Correspondence to Dr Mira Ghneim; mira.ghneim{at}som.umaryland.edu

    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.

    • brain injuries
    • traumatic
    • geriatrics
    • intracranial pressure

    Data availability statement

    No data are available.

    http://creativecommons.org/licenses/by-nc/4.0/

    This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

    https://doi.org/10.1136/tsaco-2021-000733

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      Data availability statement

      No data are available.

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      Footnotes

      • Collaborators Geri-TBI Study Group: Charles Adams, Stephanie Lueckel (Department of Surgery, Division of Trauma and Surgical Critical Care, Rhode Island Hospital, 80 Dudley St, Providence, RI 02905, Country: United States); Jason Murry, Nikita Patel (Department of Surgery, University of Texas Health Science Center at Tyler, 11937 US-271, Tyler, TX 75708, Country: United States); Cindy Hsu, Umer F. Bhatti (Department of Emergency Medicine, University of Michigan, 500 S State St, Ann Arbor, MI 48109, Country: United States); Matthew E Lissauer, Marc LaFonte (Department of Surgery, Rutgers-Robert Wood Johnson Medical School, Clinical Academic Building, 125 Paterson St, New Brunswick, NJ 08901,Country: United States);Kaveh Najafi DO, Karen Lewandowski RN (Department of Surgery, Honor Health Scottdale Osborn Medical Center, 7400 E Osborn Rd, Scottsdale, AZ 85251,Country: United States); Kaushik Mukherjee, Kristelle J. Imperio-Lagabon (Department of Surgery, Loma Linda University Medical Center, 11290 Campus St., Suite 200, Loma Linda, CA 92354, Country: United States); Niels D. Martin, Kathleen Hirsch (Department of Surgery, Division of Trauma and Surgical Critical Care, University of Pennsylvania, 3400 Civic Center Boulevard West Pavilion, 2nd Floor & 4th Floor, Philadelphia, PA19104, Country: United States); Cherisse Berry, Derek Freitas (Department of Surgery, Division of Acute Care Surgery, New York University/Bellevue Hospital Center, 462 1st Avenue, New York, NY 10016, Country: United States); Daniel Cullinane, Roshini Ramawi (Department of Surgery, Marshfield Clinic, 1000 N Oak Ave, Marshfield, WI 54449, Country: United States); Michael Truitt, Chris Pearcy (Department of Surgery, Methodist Dallas Medical Center, 1441 N Beckley Ave, Dallas, TX 75203, Country: United States); Habiba Hashimi., Krista Kaups, (Department of Surgery, University of California San Francisco Fresno, 155 N Fresno St, Fresno, CA 93701, Country: United States); Jeffry Claridge, Husayn Ladhani (Department of Surgery, MetroHealth Medical Center, 2500 Metrohealth Dr, Cleveland, OH 44109, Country: United States); Jennifer L. Hartwell (Department of Surgery, Indiana University Health Methodist, 1701 N Senate Ave, Indianapolis, IN 46202, Country: United States; Department of Surgery, Indiana University at Eskenazi Healthm, 720 Eskenazi Avenue, Indianapolis, IN 46202, Country: United States); Jessica Ballou MD (Department of Surgery, Division of Trauma, Critical Care and Acute Care Surgery, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, Country: United States); Martin Croce (Department of Surgery, University of Tennessee Health Science Center, 920 Madison Ave, Memphis, TN 38163, Country: United States); Stephanie Markle DO, Sally Osserwaarde (Department of Surgery, Ascension Borgess, 1521 Gull Rd, Kalamazoo, MI 49048, Country: United States); Joseph Posluszny, Benjamin Stocker (Department of Surgery, Division of Trauma and Critical Care, Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL 60611, Country: United States); Tjasa Hranjec, Rachele Solomon (Department of Surgery, Division of Trauma and Acute Care Surgery, Memorial Regional Hospital, 1150 N 35th Ave Suite 600, Hollywood, FL 33021, Country: United States); Lucy Martinek, Alok Gupta (Department of Surgery, Division of Trauma and Surgical Critical Care, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215, Country: United States);Daniel J. Grabo, Uzer Khan (Department of Surgery, Division of Trauma, Acute Care Surgery and Surgical Critical Care, West Virginia University,1 Medical Center Dr, Morgantown, WV 26506, Country: United States);Danielle Tatum, Tomas Jacome MD (Department of Surgery, Division of Trauma, Our Lady of the Lake Regional Medical Center, 5000 Hennessy Blvd, Baton Rouge, LA 70808, Country: United States); Jonathan Gates MD, Alisha Jawani (Department of Surgery, Hartford Hospital, 80 Seymour St, Hartford, CT 06106, Country: United States); Allison E. Berndtson, Terry G. Curry RN (Department of Surgery, Division of Trauma and Surgical Critical Care, University of California San Diego Medical Center, 9500 Gilman Drive La Jolla, CA 92093, Country: United States); Miklosh Bala (Department of Surgery, Division of Trauma and Acute Care Surgery, Hadassah Hebrew University Medical Center, Sderot Churchill 8, Jerusalem, Country: Israel); Linda A. Dultz MD, Natasha N. Houshmand (Department of Surgery, Division of Burn, Trauma and Surgical Critical Care, The University of Texas Southwestern Medical Center, Parkland Hospital, 5200 Harry Hines Blvd, Dallas, TX 75235, Country: United States);Paola Pieri (Department of Surgery, Division of Trauma and Surgical Critical Care, Maricopa Intergrated Health Systems, 2601 E Roosevelt St, Phoenix, AZ 85008, Country: United States); Martin D Zielinski, Joy D. Hughes (Department of Surgery, Division of Trauma, Critical Care and General Surgery, Mayo Clinic Rochester, 201 W Center St, Rochester, MN 55902, Country: United States); Jennifer Hartwell (Department of Surgery, Indiana University at Eskenazi Health, 720 Eskenazi Avenue, Indianapolis, IN 46202, Country: United States); Ajai K. Malhotra, Tim Lee (Department of Surgery, Division of Acute Care Surgery, University of Vermont, Burlington, 111 Colchester Avenue, Burlington, Vermont 05401, Country: United States); Patrizio Petrone, D'andrea Joseph (Department of Surgery, New York University Winthrop Hospital, 259 1st St, Mineola, NY 11501, Country: United States); Gary T. Marshall, Matthew M. Carrick (Department of Surgery, Medical Center of Plano, 3901 W 15th St, Plano, TX 75075, Country: United States); Abhijit Pathak, Andrea Van Zandt (Department of Surgery, Temple University Hospital, 3401 N Broad St, Philadelphia, PA 19140, Country: United States); Nina Glass, David Livingston (Department of Surgery, Division of Trauma and Surgical Critical Care, Rutgers Medical School University Hospital, 150 Bergen St, Newark, NJ 07103, Country: United States); Shea Gregg (Department of Surgery, Bridgeport hospital, 267 Grant St, Bridgeport, CT 06610, Country: United States); Travis Webb (Department of Surgery, Medical College of Wisconsin, 8701 W Watertown Plank Rd, Wauwatosa, WI 53226, Country: United States);Byron Drumheller (Division of Trauma, Critical Care and Acute Care Surgery, R Adams Cowley Shock Trauma Center, The University of Maryland Medical Center, 22 S Greene St, Baltimore, MD 21201, Country: United States); Rosemary Kozar MD (Division of Trauma, Critical Care and Acute Care Surgery, R Adams Cowley Shock Trauma Center, The University of Maryland Medical Center, 22 S Greene St, Baltimore, MD 21201, Country: United States); Robert Barraco MD (Department of Surgery, Division of Trauma, University of San Francisco – Lehigh Valley, 1247 S Cedar Crest Blvd. Suite 202. Allentown PA 18103-6298, Country: United States); Bellal Joseph (Department of Surgery, Division of Trauma, Burn and Acute Care Surgery, The University of Arizona, 3838 N Campbell Ave #2, Tucson, AZ 85719, Country: United States).

      • Contributors Study design: DMS, JA. Data collection, data interpretation, literature review, writing, article revision and final approval: DMS, MG, JA, KB. Data analysis: JA. Data collection and critical review of article: Geri-TBI Study Group.

      • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

      • Competing interests JA’s institution has received research funding from the American Sleep Medicine Foundation, Merck, and ResMed. The following authors are part of the Trauma Surgery & Acute Care Open editorial team: associate editors: KB, Martin Croce, and Rosemary Kozar; editorial advisory board: ZC; editorial board reviewers: TJS, Ajai K Malhotra, David Livingston, Bellal Joseph, DMS, and Krista Kaups.

      • Provenance and peer review Not commissioned; internally peer reviewed.