Intracranial Pressure Monitoring in Moderate Traumatic Brain Injury: A Systematic Review and Meta-Analysis.

ABSTRACT

BACKGROUND: The principal aim of this study was to determine the prevalence of intracranial pressure (ICP) monitoring and intracranial hypertension (IHT) in patients treated for moderate traumatic brain injury (TBI). A secondary objective was to assess factors associated with ICP monitoring. METHODS: We conducted a systematic review of the literature to identify studies that assessed ICP monitoring in moderate TBI. The meta-analysis was performed by using a random-effects model. RESULTS: A total of 13 studies comprising 116,714 patients were pooled to estimate the overall prevalence of ICP monitoring and IHT (one episode or more of ICP > 20 mm Hg) after moderate TBI. The prevalence rate for ICP monitoring was 18.3% (95% confidence interval 8.1-36.1%), whereas the proportion of IHT was 44% (95% confidence interval 33.8-54.7%). Three studies were pooled to estimate the prevalence of ICP monitoring according to Glasgow Coma Scale (GCS) (≤ 10 vs. > 10). ICP monitoring was performed in 32.2% of patients with GCS ≤ 10 versus 15.2% of patients with GCS > 10 (p = 0.59). Both subgroups were highly heterogeneous. We found no other variables associated with ICP monitoring or IHT. CONCLUSIONS: The prevalence of ICP monitoring in moderate TBI is low, but the prevalence of IHT is high among patients undergoing ICP monitoring. Current literature is limited in size and quality and does not identify factors associated with ICP monitoring or IHT. Further research is needed to guide the optimal use of ICP monitoring in moderate TBI.