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

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