TY - JOUR
T1 - Perceived Utility of Intracranial Pressure Monitoring in Traumatic Brain Injury
T2 - A Seattle International Brain Injury Consensus Conference Consensus-Based Analysis and Recommendations
AU - Chesnut, Randall M.
AU - Aguilera, Sergio
AU - Buki, Andras
AU - Bulger, Eileen M.
AU - Citerio, Giuseppe
AU - Cooper, D. Jamie
AU - Arrastia, Ramon Diaz
AU - Diringer, Michael
AU - Figaji, Anthony
AU - Gao, Guoyi
AU - Geocadin, Romergryko G.
AU - Ghajar, Jamshid
AU - Harris, Odette
AU - Hawryluk, Gregory W.J.
AU - Hoffer, Alan
AU - Hutchinson, Peter
AU - Joseph, Mathew
AU - Kitagawa, Ryan
AU - Manley, Geoffrey
AU - Mayer, Stephan
AU - Menon, David K.
AU - Meyfroidt, Geert
AU - Michael, Daniel B.
AU - Oddo, Mauro
AU - Okonkwo, David O.
AU - Patel, Mayur B.
AU - Robertson, Claudia
AU - Rosenfeld, Jeffrey V.
AU - Rubiano, Andres M.
AU - Sahuquillo, Juain
AU - Servadei, Franco
AU - Shutter, Lori
AU - Stein, Deborah M.
AU - Stocchetti, Nino
AU - Taccone, Fabio Silvio
AU - Timmons, Shelly D.
AU - Tsai, Eve C.
AU - Ullman, Jamie S.
AU - Videtta, Walter
AU - Wright, David W.
AU - Zammit, Christopher
N1 - Publisher Copyright:
© 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Congress of Neurological Surgeons.
PY - 2023/8/1
Y1 - 2023/8/1
N2 - 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.
AB - 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.
KW - Algorithms
KW - Consensus development
KW - Intracranial hypertension
KW - Intracranial pressure monitoring
KW - Neurocritical care
KW - Practice guidelines
KW - Traumatic brain injury
UR - http://www.scopus.com/inward/record.url?scp=85165222133&partnerID=8YFLogxK
U2 - 10.1227/neu.0000000000002516
DO - 10.1227/neu.0000000000002516
M3 - Article
C2 - 37171175
AN - SCOPUS:85165222133
SN - 0148-396X
VL - 93
SP - 399
EP - 408
JO - Neurosurgery
JF - Neurosurgery
IS - 2
ER -