• Abhijit Lele, Nithya Kannan, Monica S Vavilala, Deepak Sharma, Mahmud Mossa-Basha, Kwesi Agyem, Charles Mock, R M Pandey, H H Dash, Ashok Mahapatra, and Deepak Gupta.
• Departments of Anesthesiology & Pain Medicine, University of Washington, Sea-ttle, Washington.
• Neurosurgery. 2019 Aug 1; 85 (2): 231-239.

BackgroundIndia has a high traumatic brain injury (TBI) burden and intracranial pressure monitoring (ICP) remains controversial but some patients may benefit.ObjectiveTo examine the association between ICP monitor placement and outcomes, and identify Indian patients with severe TBI who benefit from ICP monitoring.MethodsWe conducted a secondary analysis of a prospective cohort study at a level 1 Indian trauma center. Patients over 18 yr with severe TBI (admission Glasgow coma scale score < 8) who received tracheal intubation for at-least 48 h were examined. Propensity-based analysis using inverse probability weighting approach was used to examine ICP monitor placement within 72 h of admission and outcomes. Outcomes were in-hospital mortality and Glasgow Outcome Scale (GOS) score at discharge, 3, 6, and 12 mo. Death, vegetative, or major impairment defined unfavorable outcome.ResultsThe 200 patients averaged 36 [18 to 85] yr of age and average injury severity score of 31.4 [2 to 73]. ICP monitors were placed in 126 (63%) patients. Patients with ICP monitor placement experienced lower in-hospital mortality (adjusted relative risk [aRR]; 0.50 [0.29, 0.87]) than patients without ICP monitoring. However, there was no benefit at 3, 6, and 12 mo. With ICP monitor placement, absence of cerebral edema (aRR 0.54, 95% confidence interval 0.35-0.84), and absence of intraventricular hemorrhage (aRR 0.52, 95% confidence interval 0.33-0.82) were associated with reduced unfavorable outcomes.ConclusionICP monitor placement without cerebrospinal fluid drainage within 72 h of admission was associated with reduced in-patient mortality. Patients with severe TBI but without cerebral edema and without intraventricular hemorrhage may benefit from ICP monitoring.Copyright © 2018 by the Congress of Neurological Surgeons.

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