Testing the Impact of Protocolized Care of Patients With Severe Traumatic Brain Injury Without Intracranial Pressure Monitoring: The Imaging and Clinical Examination Protocol

被引：7

作者：

Chesnut, Randall M. ^{[1
,23
]}

Temkin, Nancy ^{[1
]}

Videtta, Walter ^{[2
]}

Lujan, Silvia ^{[3
]}

Petroni, Gustavo ^{[3
]}

Pridgeon, Jim ^{[1
]}

Dikmen, Sureyya ^{[1
]}

Chaddock, Kelley ^{[1
]}

Hendrix, Terence

Barber, Jason ^{[1
]}

Machamer, Joan ^{[1
]}

Guadagnoli, Nahuel ^{[4
]}

Hendrickson, Peter ^{[1
]}

Alanis, Victor ^{[5
]}

La Fuente, Gustavo ^{[6
]}

Lavadenz, Arturo ^{[7
]}

Merida, Roberto ^{[8
]}

Lora, Freddy Sandi ^{[9
]}

Romero, Ricardo ^{[10
]}

Pinillos, Oscar ^{[11
]}

Urbina, Zulma ^{[12
]}

Figueroa, Jairo ^{[13
]}

Ochoa, Marcelo ^{[14
]}

Davila, Rafael ^{[15
]}

Mora, Jacobo ^{[16
]}

Bustamante, Luis ^{[17
]}

Perez, Carlos ^{[18
]}

Leiva, Jorge ^{[19
]}

Carricondo, Carlos ^{[20
]}

Mazzola, Ana Maria ^{[21
]}

Guerra, Juan ^{[22
]}

机构：

[1] Univ Washington, Harborview Med Ctr, Seattle, WA USA

[2] Hosp Nacl Prof Alejandro Posadas, Med Intens, Buenos Aires, Argentina

[3] Hosp Emergencia Dr Clemente Alvarez, Rosario, Argentina

[4] Ctr Informat Invest Clin, Rosario, Argentina

[5] Hosp San Juan Dios, Med Intensiva, Santa Cruz, Bolivia

[6] Hosp Japones, Med Intensiva, Santa Cruz, Bolivia

[7] Hosp Videma, Med Intensiva, Cochabamba, Bolivia

[8] Hosp San Juan Dios, Med Intensiva, Tarija, Bolivia

[9] Hosp Obrero No 1, Med Intensiva, La Paz, Bolivia

[10] Fdn Clin Campbell, Med Intens, Barranquilla, Colombia

[11] Clin Univ Rafael Uribe, Med Intens, Cali, Colombia

[12] Hosp Erasmo Meoz ICU 1, Med Intens, Cucuta, Colombia

[13] Hosp Erasmo Meoz ICU 2, Med Intens, Cucuta, Colombia

[14] Hosp Jose Carrasco Artega, Med Intens, Cuenca, Ecuador

[15] Hosp Luis Razetti, Med Intens, Barinas, Venezuela

[16] Hosp Luis Razetti, Med Intens, Barcelona, Venezuela

[17] Delicia Concept Hosp Masvernat, Med Intens, Concordia, Entre Rios, Argentina

[18] Hosp Justo Jose de Urquiza, Med Intens, Concepcion del Uruguay, Entre Rios, Argentina

[19] Hosp Cordoba, Med Intens, Cordoba, Argentina

[20] Hosp Cent, Med Intens, Mendoza, Argentina

[21] Hosp San Felipe, Med Intens, San Nicolas, Buenos Aires, Argentina

[22] Hosp COSSMIL Mil, Med Intensiva, La Paz, Bolivia

[23] Univ Washington, Harborview Med Ctr, 325 Ninth Ave, Seattle, WA 98104 USA

来源：

NEUROSURGERY | 2023年 / 92卷 / 03期

关键词：

Intracranial hypertension; Intracranial pressure monitoring; Severe traumatic brain injury; Neurocritical care; Global health; Protocols; SEVERE HEAD-INJURY; INTENSIVE-CARE; MANAGEMENT; OUTCOMES; GUIDELINES; SCORE; SCALE;

D O I：

10.1227/neu.0000000000002251

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

BACKGROUND:Most patients with severe traumatic brain injury (sTBI) in low- or-middle-income countries and surprisingly many in high-income countries are managed without intracranial pressure (ICP) monitoring. The impact of the first published protocol (Imaging and Clinical Examination [ICE] protocol) is untested against nonprotocol management. OBJECTIVE:To determine whether patients treated in intensive care units (ICUs) using the ICE protocol have lower mortality and better neurobehavioral functioning than those treated in ICUs using no protocol. METHODS:This study involved nineteen mostly public South American hospitals. This is a prospective cohort study, enrolling patients older than 13 years with sTBI presenting within 24 h of injury (January 2014-July 2015) with 6-mo postinjury follow-up. Five hospitals treated all sTBI cases using the ICE protocol; 14 used no protocol. Primary outcome was prespecified composite of mortality, orientation, functional outcome, and neuropsychological measures. RESULTS:A total of 414 patients (89% male, mean age 34.8 years) enrolled; 81% had 6 months of follow-up. All participants included in composite outcome analysis: average percentile (SD) = 46.8 (24.0) nonprotocol, 56.9 (24.5) protocol. Generalized estimating equation (GEE) used to account for center effects (confounder-adjusted difference [95% CI] = 12.2 [4.6, 19.8], P = .002). Kaplan-Meier 6-month mortality (95% CI) = 36% (30%, 43%) nonprotocol, 25% (19%, 31%) protocol (GEE and confounder-adjusted hazard ratio [95% CI] = .69 [.43, 1.10], P = .118). Six-month Extended Glasgow Outcome Scale for 332 participants: average Extended Glasgow Outcome Scale score (SD) = 3.6 (2.6) nonprotocol, 4.7 (2.8) protocol (GEE and confounder-adjusted and lost to follow-up-adjusted difference [95% CI] = 1.36 [.55, 2.17], P = .001). CONCLUSION:ICUs managing patients with sTBI using the ICE protocol had better functional outcome than those not using a protocol. ICUs treating patients with sTBI without ICP monitoring should consider protocolization. The ICE protocol, tested here and previously, is 1 option.

引用

页码：472 / 480

页数：9

共 50 条

[21] Intracranial Pressure Monitoring in Patients With Severe Traumatic Brain Injury: Extension of the Recommendations and the Effect on Outcome by Propensity Score Matching [J].

Castano-Leon, Ana M. ;

Gomez, Pedro A. ;

Jimenez-Roldan, Luis ;

Paredes, Igor ;

Munarriz, Pablo M. ;

Panero Perez, Irene ;

Eiriz Fernandez, Carla ;

Garcia-Perez, Daniel ;

Moreno Gomez, Luis Miguel ;

Esteban Sinovas, Olga ;

Garcia Posadas, Guillermo ;

Lagares, Alfonso .

NEUROSURGERY, 2022, 91 (03) :437-449

[22] Intracranial pressure monitoring in severe traumatic brain injury: Quo Vadis? [J].

Rosenfeld, Jeffrey V. ;

Thomas, Piers A. W. ;

Hunn, Martin K. .

ANZ JOURNAL OF SURGERY, 2021, 91 (12) :2568-2570

[23] Impact of the Timing of Placement of an Intracranial Pressure Monitor on Outcomes in Children with Severe Traumatic Brain Injury [J].

Balakrishnan, Binod ;

Zhang, Liyun ;

Simpson, Pippa M. ;

Hanson, Sheila J. .

PEDIATRIC NEUROSURGERY, 2018, 53 (06) :379-386

[24] Does intracranial pressure monitoring improve outcome after severe traumatic brain injury? [J].

Fred Rincon ;

Stephan A. Mayer .

Current Neurology and Neuroscience Reports, 2006, 6 (6) :507-508

[25] Intracranial Pressure Monitoring in the Intensive Care Unit for Patients with Severe Traumatic Brain Injury: Analysis of the CENTER-TBI China Registry [J].

Yang, Chun ;

Ma, Yuxiao ;

Xie, Li ;

Wu, Xiang ;

Hui, Jiyuan ;

Jiang, Jiyao ;

Gao, Guoyi ;

Feng, Junfeng .

NEUROCRITICAL CARE, 2022, 37 (01) :160-171

[26] Intracranial pressure monitoring in adult patients with traumatic brain injury: challenges and innovations [J].

Zoerle, Tommaso ;

Beqiri, Erta ;

Akerlund, Cecilia A., I ;

Gao, Guoyi ;

Heldt, Thomas ;

Hawryluk, Gregory W. J. ;

Stocchetti, Nino .

LANCET NEUROLOGY, 2024, 23 (09) :938-950

[27] Current practice of intracranial pressure monitoring in children with severe traumatic brain injury-a nationwide prospective surveillance study in Germany [J].

Brensing, Pia ;

Greve, Sandra ;

Hojeij, Rayan ;

Dammann, Philipp ;

Felderhoff-Mueser, Ursula ;

Dohna-Schwake, Christian ;

Bruns, Nora .

FRONTIERS IN PEDIATRICS, 2024, 12

[28] The Association of Intracranial Pressure Monitoring and Mortality: A Propensity Score-Matched Cohort of Isolated Severe Blunt Traumatic Brain Injury [J].

Ahl, Rebecka ;

Sarani, Babak ;

Sjolin, Gabriel ;

Mohseni, Shahin .

JOURNAL OF EMERGENCIES TRAUMA AND SHOCK, 2019, 12 (01) :18-22

[29] Development of a Randomized Trial Comparing ICP-Monitor-Based Management of Severe Pediatric Traumatic Brain Injury to Management Based on Imaging and Clinical Examination Without ICP Monitoring-Study Protocol [J].

Chesnut, Randall ;

Temkin, Nancy ;

Pridgeon, James ;

Sulzbacher, Stephen ;

Lujan, Silvia ;

Videtta, Walter ;

Moya-Barquin, Luis ;

Chaddock, Kelley ;

Bonow, Robert ;

Petroni, Gustavo ;

Guadagnoli, Nahuel ;

Hendrickson, Peter ;

Ramirez Cortez, Grimaldo ;

Carreazo, Nilton Yhuri ;

Vargas Aymituma, Alcides ;

Anchante, Daniel ;

Caqui, Patrick ;

Ramirez, Alberto ;

Munaico Abanto, Manuel ;

Ortiz Chicchon, Manuel ;

Cenzano Ramos, Jose ;

Mazate-Mazariegos, Analy ;

Castro Darce, Maria del Carmen ;

Sierra Morales, Roberto ;

Brol Lopez, Pedro ;

Menendez, Willy ;

Posadas Gutierrez, Sofia ;

Kevin, Vicente ;

Mazariegos, Andrea ;

de Leon, Elie ;

Barrios, Rodolfo Enrique Rodas ;

Rodriguez, Sandra ;

Flores, Sandra ;

Alvarado, Ovidio ;

Flores, Luis Jose Guzman ;

Martinez, Melvin Moisa ;

Gonzalez, Pablo .

NEUROSURGERY, 2024, 94 (01) :65-71

[30] Intracranial pressure monitoring for traumatic brain injury in the modern era [J].

Padayachy, Llewellyn C. ;

Figaji, Anthony A. ;

Bullock, M. R. .

CHILDS NERVOUS SYSTEM, 2010, 26 (04) :441-452

← 1 2 3 4 5 →