Monitoring of intracranial pressure in patients with severe traumatic brain injury: an Austrian prospective multicenter study

OBJECTIVE: The goals of this study were to elucidate reasons why patients did or did not receive intracranial pressure (ICP) monitoring and to describe factors influencing hospital mortality after severe traumatic brain injury (TBI). DESIGN: Prospective multicenter cohort study. PATIENTS AND PARTICIPANTS: 88,274 patients consecutively admitted to 32 medical, surgical and mixed Austrian ICUs between 1998 and 2004. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: 1,856 patients (2.1% of all ICU admissions) exhibited severe TBI (GCS < 9); of these, 1,031 (56%) had ICP monitoring. The "worst" and the "best" cases were both less likely to receive ICP monitoring. Younger patients, female patients, and patients with isolated TBI were more likely to receive ICP monitoring. Compared with large centers ICP was monitored more frequently odds ratio (OR) 3.09, CI 2.42-3.94] in medium-sized centers. The 20% of patients with the highest likelihood to receive ICP monitoring were monitored in 91% of cases, and had the lowest hospital mortality (31%, OR 0.78, CI 0.37-1.64). Multivariate analysis revealed that severity of illness, TBI severity, isolated TBI, and the number of cases treated per year were associated with hospital outcome. Compared with the large centers, ORs for hospital mortality were 1.85 (CI 1.42-2.40) for patients from medium-sized centers and 1.91 (CI 1.24-2.93) for patients from small centers. CONCLUSIONS: ICP monitoring may possibly have some beneficial effects, but this needs further evaluation. Patients with severe TBI should be admitted to experienced centers with high patient volumes since this might improve hospital mortality rates.