External Ventricular Drain Versus Intraparenchymal Pressure Monitor in Severe Traumatic Brain Injury: A TRACK-TBI Study.

Abstract

Background and objectives: The 2 most common intracranial pressure (ICP)-monitoring devices in traumatic brain injury (TBI) are external ventricular drains (EVDs) and intraparenchymal monitors (IPMs). EVDs and IPMs differ in functionality and debate remains as to whether device selection affects patient outcomes. We aimed to determine whether the use of EVDs or IPMs for ICP monitoring was associated with better outcomes using data from severe TBI patients prospectively enrolled in the 18-center US Transforming Research and Clinical Knowledge in TBI (TRACK-TBI) study.

Methods: We included patients aged 17 years or older with severe (Glasgow Coma Scale 3-8), nonpenetrating TBI who underwent placement of an EVD or IPM within 24 hours of arrival to a TRACK-TBI study center. Groups were compared using the Fisher exact or Mann-Whitney tests, before and after propensity weighting to attempt to better balance the groups. The primary outcome was 6-month Glasgow Outcome Scale-Extended for TBI (GOSE-TBI). Secondary outcomes include hospital length of stay, survival on discharge, and 6-month neuropsychological outcomes.

Results: We analyzed 189 patients, 115 monitored with an EVD and 74 with an IPM. There was no significant difference in median 6-month GOSE-TBI between the EVD and IPM groups, 3 (2-5) and 3 (1-5), respectively (P = .201). A greater proportion of EVD patients were alive at hospital discharge (83% vs 69%), but this was no longer significant after propensity weighting (P = .091). Hospital length of stay for survivors was similar (28.0 ± 18.7 days for EVD vs 30.1 ± 24.7 days for IPM, P = .986). There were no significant differences in neuropsychological outcomes.

Conclusion: Our study of a multicenter severe TBI cohort did not find a significant difference in 6-month GOSE-TBI between patients monitored with an EVD and those monitored with an IPM. When correcting for other patient characteristics, the selection of ICP monitor type may not affect acute hospital or 6-month functional outcomes.