TY - JOUR
T1 - Mortality and long-term functional outcome associated with intracranial pressure after traumatic brain injury
AU - Badri, Shide
AU - Chen, Jasper
AU - Barber, Jason
AU - Temkin, Nancy R.
AU - Dikmen, Sureyya S.
AU - Chesnut, Randall M.
AU - Deem, Steven
AU - Yanez, N. David
AU - Treggiari, Miriam M.
PY - 2012/11
Y1 - 2012/11
N2 - 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.
AB - 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.
KW - Critical care
KW - Functional outcome
KW - Intracranial hypertension
KW - Intracranial pressure
KW - Neuropsychological tests
KW - Traumatic brain injury
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U2 - 10.1007/s00134-012-2655-4
DO - 10.1007/s00134-012-2655-4
M3 - Article
C2 - 23011528
AN - SCOPUS:84868207818
SN - 0342-4642
VL - 38
SP - 1800
EP - 1809
JO - Intensive Care Medicine
JF - Intensive Care Medicine
IS - 11
ER -