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380 Effects and Clinical Characteristics of Intracranial Pressure Monitoring Targeted Management for Subsets of Traumatic Brain Injury: An Observational Multicenter Study.

INTRODUCTION
It became increasingly necessary to rethink the value and clinical implication of traumatic brain injury (TBI) management guided by intracranial pressure (ICP) monitoring.


METHODS
A retrospective observational multicenter study was conducted. Data were collected on adult moderate or severe TBI patients treated from January 2012 to December 2013 in 22 hospitals (16 level I trauma centers and 6 level II trauma centers) of 9 Chinese provinces. All data were collected by physicians from medical records. The 6-month mortality and favorable outcome were assessed with the Glasgow Outcome Scale Extended score.


RESULTS
An ICP monitor was inserted into 838 patients (58.1%). The significant predictors of ICP monitoring included the mechanism of injury, a Glasgow Coma Scale score of 9 to 12 at admission that dropped to a score of 3 to 8 within 24 hours after injury, a Marshall CT classification of III to IV, the presence of a major extracranial injury, subdural hematoma, intraparenchymal lesions, trauma center level, and intracranial pressure monitoring utilization of hospital. Multivariate logistic regression analyses showed that ICP monitoring resulted in a significantly lower 6-month mortality for patients who had a Glasgow Coma Scale score of 3 to 5 at admission (adjusted odds ratio, 0.57; 95% confidence interval [CI], 0.36-0.90), those who had a Glasgow Coma Scale score of 9 to 12 at admission that dropped to 3 to 8 within 24 hours after injury (adjusted odds ratio, 0.28; 95% CI, 0.08-0.96), and those who had a probability of death at 6 months greater than 0.6 (adjusted odds ratio, 0.55; 95% CI, 0.32-0.94).


CONCLUSION
There were multiple differences between the ICP monitoring and no ICP monitoring groups regarding patient characteristics, injury severity, characteristics of CT scan, and hospital type. ICP monitoring in conjunction with ICP targeted therapies is significantly associated with lower mortality in some special TBI subgroups.