The impact of intracranial pressure monitoring on mortality in patients with severe traumatic brain injury

Abstract

OVERVIEW OF THE TOPIC: Traumatic brain injuries (TBIs) remain a common global cause of death. Existing guidelines recommend the use of intracranial pressure (ICP) monitoring in the management of severe TBI. However, due to limited evidence, the relationship between ICP monitoring and mortality remains unclear. RESEARCH QUESTION: Using the Population Intervention Comparison Outcome (PICO) framework, the following research question was formulated: “In adult patients suffering from a severe traumatic brain injury (P), does intracranial pressure monitoring (I) reduce mortality (O)?” SEARCH METHODS: A methodical search for literature was conducted through HyDi, PubMed, EBSCO host and Google Scholar. Different keywords were used to generate relevant studies which included: traumatic brain injury, TBI, intracranial pressure monitor*, mortality and survival. Studies were restricted to specific study designs, namely Systematic Reviews (SRs), Meta-Analyses (MAs), Randomised Controlled Trials (RCTs) and cohort studies. Studies focusing on adult patients who suffered a severe TBI were included while those which focused on a younger population or milder injuries were excluded. Studies which did not explore mortality as their primary outcome were also excluded. Following this search for literature, a total of eighty studies were retrieved, eight of which were selected for further appraisal. These comprised of two SRs with MAs and six cohort studies. Quality assessment of the selected articles was done with the use of the appropriate critical appraisal tool from the Critical Appraisal Skills Programme (CASP). RESULTS: The results of the appraised studies differed from one another. The two SRs and one cohort study found no significant difference in mortality between patients who were ICP monitored and those who were not. Three cohort studies found a reduction in mortality with ICP monitoring while two cohort studies concluded that ICP monitoring increases mortality. CONCLUSION: A clear conclusion about the relationship between ICP monitoring and mortality in severe TBI patients cannot be made since the results of the selected studies are not congruent. RECOMMENDATIONS: The incongruities in the results clearly show that there is a great need for future research. Stronger evidence is needed to better understand the impact that ICP monitoring can have on mortality in patients with severe TBI. Until stronger evidence emerges, it is recommended that healthcare professionals involved in the use of ICP monitoring are provided with extensive knowledge and training on how to safely and adequately use the monitoring equipment.