@article{e67862b32908478ea9a74a213f451bb0,
title = "Perceived Utility of Intracranial Pressure Monitoring in Traumatic Brain Injury: A Seattle International Brain Injury Consensus Conference Consensus-Based Analysis and Recommendations",
abstract = "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.",
keywords = "Algorithms, Consensus development, Intracranial hypertension, Intracranial pressure monitoring, Neurocritical care, Practice guidelines, Traumatic brain injury",
author = "Chesnut, {Randall M.} and Sergio Aguilera and Andras Buki and Bulger, {Eileen M.} and Giuseppe Citerio and Cooper, {D. Jamie} and Arrastia, {Ramon Diaz} and Michael Diringer and Anthony Figaji and Guoyi Gao and Geocadin, {Romergryko G.} and Jamshid Ghajar and Odette Harris and Hawryluk, {Gregory W.J.} and Alan Hoffer and Peter Hutchinson and Mathew Joseph and Ryan Kitagawa and Geoffrey Manley and Stephan Mayer and Menon, {David K.} and Geert Meyfroidt and Michael, {Daniel B.} and Mauro Oddo and Okonkwo, {David O.} and Patel, {Mayur B.} and Claudia Robertson and Rosenfeld, {Jeffrey V.} and Rubiano, {Andres M.} and Juain Sahuquillo and Franco Servadei and Lori Shutter and Stein, {Deborah M.} and Nino Stocchetti and Taccone, {Fabio Silvio} and Timmons, {Shelly D.} and Tsai, {Eve C.} and Ullman, {Jamie S.} and Walter Videtta and Wright, {David W.} and Christopher Zammit",
note = "Funding Information: The authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article. Giuseppe Citerio has financial relationships with Integra and Neuroptics. Jamshid Ghajar is President of the Brain Trauma Foundation. Ramon Diaz Arrastia is supported by NIH/NINDS and the US Department of Defense. Peter Hutchinson is support by the UK NIHR (Senior Investigator Award, Biomedical Research Centre, Brain Injury Medtech Co-operative and Research Group on Global Neurotrauma) and the Royal College of Surgeons of England. David K. Menon has personal fees from Lantmannen AB, GlaxoSmithKline plc, Calico Life Sciences LLC, PressSura Neuro, Integra Neurosciences, and NeuroTrauma Sciences, LLC, has grant support from GlaxoSmithKline plc, and a shared National Institutes of Health grant from Gryphon Collaborators on a grant application outside the presented work. Daniel B. Michael declares support from the European Commission under the seventh Framework Programme (FP7-270259-TBIcare; and grant 602150—CENTER-TBI), Medical Research Council (UK) Program Grant [Acute brain injury: heterogeneity of mechanisms, therapeutic targets and outcome effects (G9439390 ID 65883)], and the UK National Institute of Health Research (NIHR) through the Biomedical Research Centre at Cambridge. Mayur B. Patel received travel support for the SIBICC meeting, and has multiple federal grants related to brain injury. Funding Information: All authors contributed to the study conception and contributed equally to the consensus process. Material preparation, data collection, and analysis were performed by Randall M Chesnut, with the kind assistance of Nancy Temkin and Jason Barber. The first draft of the manuscript was written by Randall M Chesnut, and all authors commented on the three iterations of the manuscript. All authors read and approved the final manuscript. The authors wish to acknowledge Nancy Temkin, PhD, for assistance with statistical analyses; Peter Hendrickson, PhD, for managing our web-based surveys; Jason Barber MS for assistance with statistical analyses and matrix design; and Kelley Chaddock, BA, for organizational and managerial help. We also wish to thank our financial supporters for the original SIBICC consensus conference effort who include Adler/Geirsch Attorney at Law, the American Association of Neurological Surgeons/Congress of Neurological Surgeons Section on Neurotrauma and Critical Care, Bard, the Brain Trauma Foundation, DePuy, Hemedex, Integra, the Neurointensive Care Section of the European Society of Intensive Care Medicine, Neurosurgery Society of Australasia, Medtronic, Moberg Research, Natus, Neuroptics, Raumdic, Sophysa, Stryker, and Zoll. PJH is supported by the NIHR (Research Professorship, Cambridge BRC and Global Health Research Group on Neurotrauma), and DKM is an Emeritus Senior Investigator of the National Institute of Health Research (UK). Publisher Copyright: {\textcopyright} 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Congress of Neurological Surgeons.",
year = "2023",
month = aug,
day = "1",
doi = "10.1227/neu.0000000000002516",
language = "English",
volume = "93",
pages = "399--408",
journal = "Neurosurgery",
issn = "0148-396X",
publisher = "Oxford University Press, USA",
number = "2",
}