Bardiya Zangbar, Aryan Rafieezadeh, Kartik Prabhakaran, Joshua Klein, Matthew Bronstein, Ilya Shnaydman, Chirag Gandhi, Peter Rhee
{"title":"对老年创伤患者进行颅内压监测可能不会改善预后，但与资源利用率的增加有关。","authors":"Bardiya Zangbar, Aryan Rafieezadeh, Kartik Prabhakaran, Joshua Klein, Matthew Bronstein, Ilya Shnaydman, Chirag Gandhi, Peter Rhee","doi":"10.1136/tsaco-2024-001644","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Intracranial pressure (ICP) monitoring (ICPM) is currently recommended for severe traumatic brain injury (TBI). The hypothesis was that ICPM does not change mortality in the geriatric patient population.</p><p><strong>Methods: </strong>The Trauma Quality Improvement Program (TQIP) database (2017-2021) was queried to identify intubated geriatric patients (≥65 years of age) with isolated blunt TBI (non-Head Abbreviated Injury Scale (AIS) score <3), with admission Glasgow Coma Scale (GCS) scores of 3-8. Patients with death on arrival or with hospital length of stay <24 hours and patients who underwent craniotomy before ICPM placement were excluded. Favorable discharge disposition was defined as home with or without assistance, and rehabilitation. Propensity score matching (PSM) was performed between ICPM and non-ICPM patients and outcomes were compared. The primary outcome was defined as in-hospital mortality. Secondary outcomes were defined as discharge disposition, hospital length of stay, intensive care unit (ICU) length of stay and ventilator days.</p><p><strong>Results: </strong>A total of 19 416 patients met criteria for analysis. ICPM was placed in only 12.1% (n=2363) patients. The Injury Severity Score, GCS and head AIS were similar between the patients with and without monitors. After PSM, we were able to match 2148 patients and there was no difference in mortality between the two groups (52.4% vs 52.1%, p=0.874); however, patients treated with ICPM had significantly longer hospital length of stay (10 (5-17) vs 7 (3-15) days, p<0.001), ICU length of stay (8 (4-14) vs 6 (3-10), p<0.001) and ventilator days (6 (3-11) vs 4 (2-7), p<0.001). Discharge disposition was trending towards unfavorable with increasing age but was similar between the ICPM and No-ICPM groups (p=0.115).</p><p><strong>Conclusion: </strong>The usefulness of ICPM in geriatric patients has not yet been shown and would benefit from prospective clinical studies. 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The hypothesis was that ICPM does not change mortality in the geriatric patient population.</p><p><strong>Methods: </strong>The Trauma Quality Improvement Program (TQIP) database (2017-2021) was queried to identify intubated geriatric patients (≥65 years of age) with isolated blunt TBI (non-Head Abbreviated Injury Scale (AIS) score <3), with admission Glasgow Coma Scale (GCS) scores of 3-8. Patients with death on arrival or with hospital length of stay <24 hours and patients who underwent craniotomy before ICPM placement were excluded. Favorable discharge disposition was defined as home with or without assistance, and rehabilitation. Propensity score matching (PSM) was performed between ICPM and non-ICPM patients and outcomes were compared. The primary outcome was defined as in-hospital mortality. Secondary outcomes were defined as discharge disposition, hospital length of stay, intensive care unit (ICU) length of stay and ventilator days.</p><p><strong>Results: </strong>A total of 19 416 patients met criteria for analysis. ICPM was placed in only 12.1% (n=2363) patients. The Injury Severity Score, GCS and head AIS were similar between the patients with and without monitors. After PSM, we were able to match 2148 patients and there was no difference in mortality between the two groups (52.4% vs 52.1%, p=0.874); however, patients treated with ICPM had significantly longer hospital length of stay (10 (5-17) vs 7 (3-15) days, p<0.001), ICU length of stay (8 (4-14) vs 6 (3-10), p<0.001) and ventilator days (6 (3-11) vs 4 (2-7), p<0.001). Discharge disposition was trending towards unfavorable with increasing age but was similar between the ICPM and No-ICPM groups (p=0.115).</p><p><strong>Conclusion: </strong>The usefulness of ICPM in geriatric patients has not yet been shown and would benefit from prospective clinical studies. 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引用次数: 0
摘要
背景：颅内压（ICP）监测（ICPM）目前被推荐用于严重创伤性脑损伤（TBI）。假设ICPM不会改变老年患者群体的死亡率。方法：查询创伤质量改善计划（TQIP）数据库（2017-2021），确定孤立性钝性TBI(非头部简易损伤量表（AIS）评分的插管老年患者（≥65岁）。结果：共有19416例患者符合分析标准。只有12.1% （n=2363）的患者使用ICPM。有无监护仪患者的损伤严重程度评分、GCS和头部AIS相似。PSM后，我们匹配了2148例患者，两组死亡率无差异（52.4% vs 52.1%, p=0.874）；然而，接受ICPM治疗的患者住院时间明显更长（10（5-17）天和7（3-15）天）。结论：ICPM对老年患者的有用性尚未得到证实，它将受益于前瞻性临床研究。尽量减少老年患者的ICPM可以在不影响结果的情况下减少资源负担。证据等级：III级回顾性研究。
Intracranial pressure monitoring in patients with geriatric trauma may not improve outcome but is associated with increases in resource utilization.
Background: Intracranial pressure (ICP) monitoring (ICPM) is currently recommended for severe traumatic brain injury (TBI). The hypothesis was that ICPM does not change mortality in the geriatric patient population.
Methods: The Trauma Quality Improvement Program (TQIP) database (2017-2021) was queried to identify intubated geriatric patients (≥65 years of age) with isolated blunt TBI (non-Head Abbreviated Injury Scale (AIS) score <3), with admission Glasgow Coma Scale (GCS) scores of 3-8. Patients with death on arrival or with hospital length of stay <24 hours and patients who underwent craniotomy before ICPM placement were excluded. Favorable discharge disposition was defined as home with or without assistance, and rehabilitation. Propensity score matching (PSM) was performed between ICPM and non-ICPM patients and outcomes were compared. The primary outcome was defined as in-hospital mortality. Secondary outcomes were defined as discharge disposition, hospital length of stay, intensive care unit (ICU) length of stay and ventilator days.
Results: A total of 19 416 patients met criteria for analysis. ICPM was placed in only 12.1% (n=2363) patients. The Injury Severity Score, GCS and head AIS were similar between the patients with and without monitors. After PSM, we were able to match 2148 patients and there was no difference in mortality between the two groups (52.4% vs 52.1%, p=0.874); however, patients treated with ICPM had significantly longer hospital length of stay (10 (5-17) vs 7 (3-15) days, p<0.001), ICU length of stay (8 (4-14) vs 6 (3-10), p<0.001) and ventilator days (6 (3-11) vs 4 (2-7), p<0.001). Discharge disposition was trending towards unfavorable with increasing age but was similar between the ICPM and No-ICPM groups (p=0.115).
Conclusion: The usefulness of ICPM in geriatric patients has not yet been shown and would benefit from prospective clinical studies. Minimizing ICPM in geriatric patients may reduce resource burdening without affecting outcome.
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