Comparative effectiveness of intracranial hypertension management guided by ventricular versus intraparenchymal pressure monitoring: a CENTER-TBI study
Victor Volovici, Dana Pisică, Benjamin Gravesteijn, Clemens M.F. Dirven, Ewout W. Steyerberg, Ari Ercole, Nino Stocchetti, David Nelson, David Menon, Giuseppe Citerio, Mathieu van der Jagt, Andrew I.R. Maas, Iain Haitsma, Hester F. Lingsma, Cecilia Åkerlund, Krisztina Amrein, Nada Anđelić, Lasse Andreassen, Gérard Audibert, Philippe Azouvi, Maria Luisa Azzolini, Ronald Bartels, Ronny Beer, Bo‐Michael Bellander, Habib Benali, Maurizio Berardino, Luigi Beretta, Erta Beqiri, Morten Blaabjerg, Stine Lund, Camilla Brorsson, András Büki, 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, Marta Correia, Endre Czeiter, Marek Czosnyka, Claire Dahyot‐Fizelier, Paul Dark, Véronique De Keyser, Vincent Degos, Françesco Della Corte, Hugo den Boogert, Bart Depreitere, Đula Đilvesi, Abhishek Dixit, Jens P. Dreier, Guy‐Loup Dulière, Erzsébet Ezer, Martin Fabricius, Kelly Foks, Shirin Frisvold, Alex Furmanov, Damien Galanaud, Dashiell Gantner, Alexandre Ghuysen, Lelde Giga, Jagoš Golubović, Pedro A. Gómez, Francesca Grossi, Deepak Gupta, Iain Haitsma, Eirik Helseth, Peter J. Hutchinson, Stefan Jankowski, Faye Johnson, Mladen Karan, Angelos G. Kolias, Daniel Kondziella, Evgenios Koraropoulos, Lars‐Owe Koskinen, Noémi Kovács, Ana Kowark, Alfonso Lagares, Steven Laureys, Didier Ledoux, Aurélie Lejeune, Roger Lightfoot, Alex Manara, Costanza Martino, Hugues Maréchal, Julia Mattern, Catherine McMahon, Tomas Menovsky, Benoît Misset, Visakh Muraleedharan, Lynnette Murray, Ancuța Negru, Virginia Newcombe
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).