Research Reports - Mortality and long-term functional outcome associated with intracranial pressure after traumatic brain injury

Intensive Care Med. 2012 Nov;38(11):1800-9

Badri S, Chen J, Barber J, Temkin NR, Dikmen SS, Chesnut RM, Deem S, Yanez ND, Treggiari MM

PURPOSE: Elevated intracranial pressure (ICP) has been associated with increased
mortality in patients with severe traumatic brain injury (TBI). We have examined
whether raised ICP is independently associated with mortality, functional status
and neuropsychological functioning in adult TBI patients.
METHODS: Data from a randomized trial of 499 participants were secondarily
analyzed. The primary endpoints were mortality and a composite measure of
functional status and neuropsychological function (memory, speed of information
processing, executive function) over a 6-month period. The area under the curve
of the ICP profile (average ICP) during the first 48 h of monitoring was the main
predictor of interest. Multivariable regression was used to adjust for a priori
defined confounders: age, Glasgow Coma Score, Abbreviated Injury Scale-head and
hypoxia.
RESULTS: Of the participants, 365 patients had complete 48-h ICP data. The
overall 6-month mortality was 18 %. The adjusted odds ratio of mortality
comparing 10-mmHg increases in average ICP was 3.12 (95 % confidence interval
1.79, 5.44; p < 0.01). Overall, higher average ICP was associated with decreased
functional status and neuropsychological functioning (p < 0.01). Importantly,
among survivors, increasing average ICP was not independently associated with
worse performance on neuropsychological testing (p = 0.46).
CONCLUSIONS: Average ICP in the first 48 h of monitoring was an independent
predictor of mortality and of a composite endpoint of functional and
neuropsychological outcome at the 6-month follow-up in moderate or severe TBI
patients. However, there was no association between average ICP and
neuropsychological functioning among survivors.

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