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Comparative effectiveness of intracranial hypertension management guided by ventricular versus intraparenchymal pressure monitoring: a CENTER-TBI study.

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cam.issuedOnline2022-06
dc.contributor.authorVolovici, Victor
dc.contributor.authorPisică, Dana
dc.contributor.authorGravesteijn, Benjamin Y
dc.contributor.authorDirven, Clemens MF
dc.contributor.authorSteyerberg, Ewout W
dc.contributor.authorErcole, Ari
dc.contributor.authorStocchetti, Nino
dc.contributor.authorNelson, David
dc.contributor.authorMenon, David K
dc.contributor.authorCiterio, Giuseppe
dc.contributor.authorvan der Jagt, Mathieu
dc.contributor.authorMaas, Andrew IR
dc.contributor.authorHaitsma, Iain K
dc.contributor.authorLingsma, Hester F
dc.contributor.authorCENTER-TBI investigators, participants for the ICU stratum
dc.contributor.orcidVolovici, Victor [0000-0002-5798-5360]
dc.date.accessioned2022-07-03T01:02:39Z
dc.date.available2022-07-03T01:02:39Z
dc.date.issued2022-07
dc.date.updated2022-07-03T01:02:39Z
dc.descriptionFunder: ZNS - Hannelore Kohl Stiftung
dc.descriptionFunder: Integra LifeSciences
dc.description.abstractOBJECTIVE: To compare outcomes between patients with primary external ventricular device (EVD)-driven treatment of intracranial hypertension and those with primary intraparenchymal monitor (IP)-driven treatment. METHODS: The CENTER-TBI study is a prospective, multicenter, longitudinal observational cohort study that enrolled patients of all TBI severities from 62 participating centers (mainly level I trauma centers) across Europe between 2015 and 2017. Functional outcome was assessed at 6 months and a year. We used multivariable adjusted instrumental variable (IV) analysis with "center" as instrument and logistic regression with covariate adjustment to determine the effect estimate of EVD on 6-month functional outcome. RESULTS: A total of 878 patients of all TBI severities with an indication for intracranial pressure (ICP) monitoring were included in the present study, of whom 739 (84%) patients had an IP monitor and 139 (16%) an EVD. Patients included were predominantly male (74% in the IP monitor and 76% in the EVD group), with a median age of 46 years in the IP group and 48 in the EVD group. Six-month GOS-E was similar between IP and EVD patients (adjusted odds ratio (aOR) and 95% confidence interval [CI] OR 0.74 and 95% CI [0.36-1.52], adjusted IV analysis). The length of intensive care unit stay was greater in the EVD group than in the IP group (adjusted rate ratio [95% CI] 1.70 [1.34-2.12], IV analysis). One hundred eighty-seven of the 739 patients in the IP group (25%) required an EVD due to refractory ICPs. CONCLUSION: We found no major differences in outcomes of patients with TBI when comparing EVD-guided and IP monitor-guided ICP management. In our cohort, a quarter of patients that initially received an IP monitor required an EVD later for ICP control. The prevalence of complications was higher in the EVD group. PROTOCOL: The core study is registered with ClinicalTrials.gov , number NCT02210221, and the Resource Identification Portal (RRID: SCR_015582).
dc.identifier.doi10.17863/CAM.86130
dc.identifier.eissn0942-0940
dc.identifier.issn0001-6268
dc.identifier.otherPMC9233652
dc.identifier.other35648213
dc.identifier.urihttps://www.repository.cam.ac.uk/handle/1810/338717
dc.languageeng
dc.language.isoeng
dc.publisherSpringer Science and Business Media LLC
dc.publisher.urlhttp://dx.doi.org/10.1007/s00701-022-05257-z
dc.rightsAttribution 4.0 International
dc.rights.urihttps://creativecommons.org/licenses/by/4.0/
dc.sourceessn: 0942-0940
dc.sourcenlmid: 0151000
dc.subjectCENTER-TBI
dc.subjectEVD
dc.subjectExternal ventricular devices
dc.subjectICP
dc.subjectIntracranial hypertension
dc.subjectIntracranial pressure monitoring
dc.subjectIntraparenchymal monitors
dc.subjectSevere TBI
dc.subjectTraumatic brain injury
dc.subjectFemale
dc.subjectHumans
dc.subjectMale
dc.subjectMiddle Aged
dc.subjectBrain Injuries, Traumatic
dc.subjectIntracranial Hypertension
dc.subjectIntracranial Pressure
dc.subjectMonitoring, Physiologic
dc.subjectProspective Studies
dc.titleComparative effectiveness of intracranial hypertension management guided by ventricular versus intraparenchymal pressure monitoring: a CENTER-TBI study.
dc.typeArticle
dcterms.dateAccepted2022-05-11
prism.endingPage1705
prism.issueIdentifier7
prism.publicationNameActa Neurochir (Wien)
prism.startingPage1693
prism.volume164
pubs.funder-project-idEuropean Commission (602150)
rioxxterms.licenseref.urihttps://creativecommons.org/licenses/by/4.0/
rioxxterms.versionVoR
rioxxterms.versionofrecord10.1007/s00701-022-05257-z

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