Michael D Gaziano, Peter Aziz, Alison Muller, Anthony Martin, H Christopher Lawson, Eugene F Reilly, Christopher A Butts, Thomas A Geng, Adrian W Ong
{"title":"颅内压监测仪在孤立性创伤性脑损伤中的植入:时机重要吗?","authors":"Michael D Gaziano, Peter Aziz, Alison Muller, Anthony Martin, H Christopher Lawson, Eugene F Reilly, Christopher A Butts, Thomas A Geng, Adrian W Ong","doi":"10.1177/00031348251363504","DOIUrl":null,"url":null,"abstract":"<p><p>BackgroundIntracranial pressure monitoring (ICPM) is recommended in selected patients with severe traumatic brain injury (sTBI). Optimal timing of ICPM insertion after sTBI is not well studied. We aimed to evaluate if timing of ICPM insertion would impact outcomes.Materials and MethodsWe utilized data from 2018 to 2021 from the American College of Surgeons Trauma Quality Improvement Program. Patients ≥16 years from level 1 and 2 trauma centers with isolated blunt sTBI were included. Nonsurvivable brain injury (AIS-head = 6) and those needing emergent open cranial (OC) procedures within 2 hours of admission were excluded. Timing of ICPM insertion was categorized as follows: no ICPM insertion, ≤4 h, >4 to ≤12 h, and >12 h. Binary logistic regression analysis was used to assess variables associated with mortality.Results17 715 patients were included. 2525 (14%) had ICPM placed, 2613 (15%) underwent open cranial surgery, and 8757 (49%) died. There was no ICPM insertion in 86% while 8%, 4%, and 2% underwent ICPM insertion ≤4 h, >4 to ≤12 h, and >12 h, respectively. Compared to no ICPM, insertion ≤4 h (odds ratio [OR] 0.94 [0.82-1.09]), >4 to ≤12 h (OR 1.18 [0.97-1.43]), and >12 h (OR 1.02 [0.81-1.31]), respectively, were not associated with mortality. Open cranial procedure was associated with reduced risk of death (OR 0.40 [0.36-0.45]).DiscussionFor blunt isolated sTBI, Timing of ICPM insertion was not associated with mortality reduction. Early ICPM insertion may be less important than expeditious OC.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"1845-1850"},"PeriodicalIF":0.9000,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Intracranial Pressure Monitor Insertion in Isolated Traumatic Brain Injury: Does Timing Matter?\",\"authors\":\"Michael D Gaziano, Peter Aziz, Alison Muller, Anthony Martin, H Christopher Lawson, Eugene F Reilly, Christopher A Butts, Thomas A Geng, Adrian W Ong\",\"doi\":\"10.1177/00031348251363504\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p>BackgroundIntracranial pressure monitoring (ICPM) is recommended in selected patients with severe traumatic brain injury (sTBI). Optimal timing of ICPM insertion after sTBI is not well studied. We aimed to evaluate if timing of ICPM insertion would impact outcomes.Materials and MethodsWe utilized data from 2018 to 2021 from the American College of Surgeons Trauma Quality Improvement Program. Patients ≥16 years from level 1 and 2 trauma centers with isolated blunt sTBI were included. Nonsurvivable brain injury (AIS-head = 6) and those needing emergent open cranial (OC) procedures within 2 hours of admission were excluded. Timing of ICPM insertion was categorized as follows: no ICPM insertion, ≤4 h, >4 to ≤12 h, and >12 h. Binary logistic regression analysis was used to assess variables associated with mortality.Results17 715 patients were included. 2525 (14%) had ICPM placed, 2613 (15%) underwent open cranial surgery, and 8757 (49%) died. There was no ICPM insertion in 86% while 8%, 4%, and 2% underwent ICPM insertion ≤4 h, >4 to ≤12 h, and >12 h, respectively. Compared to no ICPM, insertion ≤4 h (odds ratio [OR] 0.94 [0.82-1.09]), >4 to ≤12 h (OR 1.18 [0.97-1.43]), and >12 h (OR 1.02 [0.81-1.31]), respectively, were not associated with mortality. Open cranial procedure was associated with reduced risk of death (OR 0.40 [0.36-0.45]).DiscussionFor blunt isolated sTBI, Timing of ICPM insertion was not associated with mortality reduction. Early ICPM insertion may be less important than expeditious OC.</p>\",\"PeriodicalId\":7782,\"journal\":{\"name\":\"American Surgeon\",\"volume\":\" \",\"pages\":\"1845-1850\"},\"PeriodicalIF\":0.9000,\"publicationDate\":\"2025-11-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"American Surgeon\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1177/00031348251363504\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/8/1 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q3\",\"JCRName\":\"SURGERY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"American Surgeon","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1177/00031348251363504","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/8/1 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"SURGERY","Score":null,"Total":0}
Intracranial Pressure Monitor Insertion in Isolated Traumatic Brain Injury: Does Timing Matter?
BackgroundIntracranial pressure monitoring (ICPM) is recommended in selected patients with severe traumatic brain injury (sTBI). Optimal timing of ICPM insertion after sTBI is not well studied. We aimed to evaluate if timing of ICPM insertion would impact outcomes.Materials and MethodsWe utilized data from 2018 to 2021 from the American College of Surgeons Trauma Quality Improvement Program. Patients ≥16 years from level 1 and 2 trauma centers with isolated blunt sTBI were included. Nonsurvivable brain injury (AIS-head = 6) and those needing emergent open cranial (OC) procedures within 2 hours of admission were excluded. Timing of ICPM insertion was categorized as follows: no ICPM insertion, ≤4 h, >4 to ≤12 h, and >12 h. Binary logistic regression analysis was used to assess variables associated with mortality.Results17 715 patients were included. 2525 (14%) had ICPM placed, 2613 (15%) underwent open cranial surgery, and 8757 (49%) died. There was no ICPM insertion in 86% while 8%, 4%, and 2% underwent ICPM insertion ≤4 h, >4 to ≤12 h, and >12 h, respectively. Compared to no ICPM, insertion ≤4 h (odds ratio [OR] 0.94 [0.82-1.09]), >4 to ≤12 h (OR 1.18 [0.97-1.43]), and >12 h (OR 1.02 [0.81-1.31]), respectively, were not associated with mortality. Open cranial procedure was associated with reduced risk of death (OR 0.40 [0.36-0.45]).DiscussionFor blunt isolated sTBI, Timing of ICPM insertion was not associated with mortality reduction. Early ICPM insertion may be less important than expeditious OC.
期刊介绍:
The American Surgeon is a monthly peer-reviewed publication published by the Southeastern Surgical Congress. Its area of concentration is clinical general surgery, as defined by the content areas of the American Board of Surgery: alimentary tract (including bariatric surgery), abdomen and its contents, breast, skin and soft tissue, endocrine system, solid organ transplantation, pediatric surgery, surgical critical care, surgical oncology (including head and neck surgery), trauma and emergency surgery, and vascular surgery.