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Mortality and long-term functional outcome associated with intracranial pressure after traumatic brain injury

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Abstract

Purpose

Elevated intracranial pressure (ICP) has been associated with increased mortality in patients with severe traumatic brain injury (TBI). We have examined whether raised ICP is independently associated with mortality, functional status and neuropsychological functioning in adult TBI patients.

Methods

Data from a randomized trial of 499 participants were secondarily analyzed. The primary endpoints were mortality and a composite measure of functional status and neuropsychological function (memory, speed of information processing, executive function) over a 6-month period. The area under the curve of the ICP profile (average ICP) during the first 48 h of monitoring was the main predictor of interest. Multivariable regression was used to adjust for a priori defined confounders: age, Glasgow Coma Score, Abbreviated Injury Scale–head and hypoxia.

Results

Of the participants, 365 patients had complete 48-h ICP data. The overall 6-month mortality was 18 %. The adjusted odds ratio of mortality comparing 10-mmHg increases in average ICP was 3.12 (95 % confidence interval 1.79, 5.44; p < 0.01). Overall, higher average ICP was associated with decreased functional status and neuropsychological functioning (p < 0.01). Importantly, among survivors, increasing average ICP was not independently associated with worse performance on neuropsychological testing (p = 0.46).

Conclusions

Average ICP in the first 48 h of monitoring was an independent predictor of mortality and of a composite endpoint of functional and neuropsychological outcome at the 6-month follow-up in moderate or severe TBI patients. However, there was no association between average ICP and neuropsychological functioning among survivors.

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Acknowledgments

The study was supported by departmental funds. The original data were collected under NIH/NINDS grant R01 NS19643.

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Authors and Affiliations

  1. Department of Anesthesiology and Pain Medicine, Harborview Anesthesiology Research Center, Harborview Medical Center, University of Washington School of Medicine, 325 Ninth Avenue, Box 359724, Seattle, WA, 98104, USA

    Shide Badri, Steven Deem & Miriam M. Treggiari

  2. Safety, Compliance and Coding Department, Amarex Clinical Research, Germantown, MD, USA

    Shide Badri

  3. Department of Anesthesiology, Kaiser Permanente, Redwood City, CA, USA

    Jasper Chen

  4. Department of Neurological Surgery, University of Washington School of Medicine, Seattle, WA, USA

    Jason Barber, Nancy R. Temkin, Sureyya S. Dikmen, Randall M. Chesnut & Miriam M. Treggiari

  5. Department of Orthopedic Surgery, University of Washington School of Medicine, Seattle, WA, USA

    Randall M. Chesnut

  6. Department of Biostatistics, University of Washington, Seattle, WA, USA

    Nancy R. Temkin & N. David Yanez

  7. Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA

    Nancy R. Temkin & Sureyya S. Dikmen

  8. Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Washington, Seattle, WA, USA

    Steven Deem

  9. Department of Epidemiology, School of Public Health and Community Medicine, Harborview Medical Center, University of Washington, 325 Ninth Avenue, Box 359724, Seattle, WA, 98104, USA

    Miriam M. Treggiari

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  1. Shide Badri
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  2. Jasper Chen
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  3. Jason Barber
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  4. Nancy R. Temkin
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  5. Sureyya S. Dikmen
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  6. Randall M. Chesnut
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  7. Steven Deem
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  8. N. David Yanez
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  9. Miriam M. Treggiari
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Corresponding author

Correspondence to Miriam M. Treggiari.

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Badri, S., Chen, J., Barber, J. et al. Mortality and long-term functional outcome associated with intracranial pressure after traumatic brain injury. Intensive Care Med 38, 1800–1809 (2012). https://doi.org/10.1007/s00134-012-2655-4

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  • DOI: https://doi.org/10.1007/s00134-012-2655-4

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