Perceived Utility of Intracranial Pressure Monitoring in Traumatic Brain Injury: A Seattle International Brain Injury Consensus Conference Consensus-Based Analysis and Recommendations

Randall M. Chesnut, Sergio Aguilera, Andras Buki, Eileen M. Bulger, Giuseppe Citerio, D. Jamie Cooper, Ramon Diaz Arrastia, Michael Diringer, Anthony Figaji, Guoyi Gao, Romergryko G. Geocadin, Jamshid Ghajar, Odette Harris, Gregory W.J. Hawryluk, Alan Hoffer, Peter Hutchinson, Mathew Joseph, Ryan Kitagawa, Geoffrey Manley, Stephan MayerDavid K. Menon, Geert Meyfroidt, Daniel B. Michael, Mauro Oddo, David O. Okonkwo, Mayur B. Patel, Claudia Robertson, Jeffrey V. Rosenfeld, Andres M. Rubiano, Juain Sahuquillo, Franco Servadei, Lori Shutter, Deborah M. Stein, Nino Stocchetti, Fabio Silvio Taccone, Shelly D. Timmons, Eve C. Tsai, Jamie S. Ullman, Walter Videtta, David W. Wright, Christopher Zammit

Research output: Contribution to journalArticlepeer-review


BACKGROUND: Intracranial pressure (ICP) monitoring is widely practiced, but the indications are incompletely developed, and guidelines are poorly followed. OBJECTIVE: To study the monitoring practices of an established expert panel (the clinical working group from the Seattle International Brain Injury Consensus Conference effort) to examine the match between monitoring guidelines and their clinical decision-making and offer guidance for clinicians considering monitor insertion. METHODS: We polled the 42 Seattle International Brain Injury Consensus Conference panel members' ICP monitoring decisions for virtual patients, using matrices of presenting signs (Glasgow Coma Scale [GCS] total or GCS motor, pupillary examination, and computed tomography diagnosis). Monitor insertion decisions were yes, no, or unsure (traffic light approach). We analyzed their responses for weighting of the presenting signs in decision-making using univariate regression. RESULTS: Heatmaps constructed from the choices of 41 panel members revealed wider ICP monitor use than predicted by guidelines. Clinical examination (GCS) was by far the most important characteristic and differed from guidelines in being nonlinear. The modified Marshall computed tomography classification was second and pupils third. We constructed a heatmap and listed the main clinical determinants representing 80% ICP monitor insertion consensus for our recommendations. CONCLUSION: Candidacy for ICP monitoring exceeds published indicators for monitor insertion, suggesting the clinical perception that the value of ICP data is greater than simply detecting and monitoring severe intracranial hypertension. Monitor insertion heatmaps are offered as potential guidance for ICP monitor insertion and to stimulate research into what actually drives monitor insertion in unconstrained, real-world conditions.

Original languageEnglish
Pages (from-to)399-408
Number of pages10
Issue number2
StatePublished - Aug 1 2023


  • Algorithms
  • Consensus development
  • Intracranial hypertension
  • Intracranial pressure monitoring
  • Neurocritical care
  • Practice guidelines
  • Traumatic brain injury


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