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

Victor Volovici*, Dana Pisică, on behalf of CENTER-TBI investigators, participants for the ICU stratum, Benjamin Y. Gravesteijn, Clemens M.F. Dirven, Ewout W. Steyerberg, Ari Ercole, Nino Stocchetti, David Nelson, David K. Menon, Giuseppe Citerio, Mathieu van der Jagt, Andrew I.R. Maas, Iain Haitsma, Hester F. Lingsma, Cecilia Åkerlund, Krisztina Amrein, Nada Andelic, Lasse Andreassen, Gérard AudibertPhilippe Azouvi, Maria Luisa Azzolini, Ronald Bartels, Ronny Beer, Bo Michael Bellander, Habib Benali, Maurizio Berardino, Luigi Beretta, Erta Beqiri, Morten Blaabjerg, Stine Borgen Lund, Camilla Brorsson, Andras Buki, Manuel Cabeleira, Alessio Caccioppola, Emiliana Calappi, Maria Rosa Calvi, Peter Cameron, Guillermo Carbayo Lozano, Ana M. Castaño-León, Simona Cavallo, Giorgio Chevallard, Arturo Chieregato, Mark Coburn, Jonathan Coles, Jamie D. Cooper, Kelly Foks, Iain Haitsma, Dick Tibboel, Daphne Voormolen, Thomas A. van Essen

*Corresponding author for this work

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Abstract

Objective: 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).

Original languageEnglish
Pages (from-to)1693-1705
Number of pages13
JournalActa Neurochirurgica
Volume164
Issue number7
Early online date1 Jun 2022
DOIs
Publication statusPublished - 1 Jul 2022

Bibliographical note

Funding Information:
The European Commission, Seventh Framework Program, grant number 602150, provided support in the form of funding for the CENTER-TBI project, not only for this study in particular. The Hannelore Kohl Stiftung (Germany), OneMind (USA), and Integra LifeSciences Corporation (USA) provided support for the CENTER-TBI project in the form of funding, not only for this study in particular. The sponsors had no role in the design or conduct of this research.

Publisher Copyright:
© 2022, The Author(s).

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