Original ArticleValue of Ventricular Intracranial Pressure Monitoring for Traumatic Bifrontal Contusions
Introduction
Traumatic brain injury (TBI) is among the most important public health problems because of its significant negative impact on the lives of the injured and their family members and its huge economic burden.1, 2, 3, 4, 5 In 2010, the combined incidence of TBI-related hospitalizations, emergency department visits, and deaths was 823.7 per 100,000, as reported by the U.S. Centers for Disease Control and Prevention.6 The incidence of traumatic neurologic injury was 55.4 patients per 100,000 in 6 big cities and 64.1 patients per 100,000 in 21 rural areas, with mortality rates of 6.3 per 100,000 (male-to-female ratio 1.7:1.0) in the 6 cities and 9.7 per 100,000 (male-to-female ratio 2.5:1) in the rural areas.7 Redelmeier et al.8 reported that TBIs caused by traffic collisions have decreased in high-income countries, but injuries resulting from other causes, such as falls, have been increasing because of the growing elderly population.9 In low-income and middle-income countries and developing countries such as Iran and China, the incidence of TBIs is increasing rapidly owing to the significant increase in road traffic collisions, including motor vehicle accidents.10, 11, 12 Zhao et al.7 reported that farmers, laborers, and children were more likely than other individuals to sustain TBIs. In a more recent study, 7145 cases of TBI treated at 47 hospitals in China were studied and showed similar results.13 TBI not only leads to physical and mental suffering for the patients but also a heavy financial burden for the family and society.14, 15, 16
Traumatic bifrontal contusions (TBCs) are relatively common in clinical practice and are often observed in patients with contrecoup head injuries, such as from traffic accidents and falls.17 The initial computed tomography (CT) scans after injury may indicate only nonsevere frontal contusions and no obliteration of the ambient cistern. These patients tend to be ignored and poorly monitored by emergency physicians in the emergency department. The condition of some patients with TBCs can rapidly deteriorate as a result of central herniation, resulting in a poor prognosis if the patients are not properly treated in time. However, it has been unclear whether surgical treatment is required. The type of surgery that should be performed is also unclear, with it being unknown whether a patient should undergo a unilateral or bilateral procedure and whether decompressive craniectomy (DC) should be included. No guidelines currently exist for treating bifrontal contusions.
Intracranial pressure (ICP) monitoring is widely used in neurointensive care, especially for the management of patients with TBI. However, ICP monitoring is not routinely recommended in patients with mild to moderate head injury (i.e., Glasgow Coma Scale [GCS] scores 9–15). However, current guidelines allow physicians to select certain conscious patients who may benefit from ICP monitoring.18 In this study, we retrospectively reviewed 387 patients with bifrontal contusions who were admitted to our institution (Rescue Center of Craniocerebral Injuries of PLA) and treated from January 2010 to January 2016. We focused on the value of ventricular intracranial pressure monitoring (V-ICPM) for patients with TBCs.
Section snippets
Patient Population
From January 2010 to January 2016, 8760 patients with acute head trauma (GCS scores 3–15) were admitted to our clinical institution, including 387 (4.4%) patients who had bifrontal contusions, as determined by CT scans. There were 280 men and 107 women, with an average age of 48 years (range, 11–83 years). Of the patients with TBCs, 105 underwent V-ICPM, and 282 did not.
The 3 most common causes of head trauma in these patients were as follows: motor vehicle crashes in 245 cases, falls in 70
Clinical Data
Between January 2010 and January 2016, 8760 patients with TBI were treated at our hospital; 387 patients met the study inclusion criteria and were enrolled in this study. Among these 387 patients with TBCs, there were 280 (72.4%) men and 107 (27.6%) women with an average age of 48 years; 105 (27.1%) patients with TBCs underwent V-ICPM, and the other 282 (72.9%) patients with TBCs did not. The 3 most common causes of head trauma were motor vehicle crashes (245 of 387; 63.3%), falls (70 of 387;
Discussion
TBI is a common occurrence in modern society and is associated with high morbidity and mortality rates.6, 7 Bifrontal contusions commonly occur in contrecoup injuries and primarily in the cortical tissue, with unique features compared with contusions in other locations.17 Many awake (mild TBI) patients with TBCs may experience rapid deterioration and brain center herniation late in the clinical course, with the characteristics of “talk and die.” The reasons for the rapid deterioration of
Conclusions
Based on the present study, we recommend that V-ICPM should be performed for patients with TBI, particularly patients with TBC, and should be widely used to guide diagnostic and therapeutic decisions. Patients with TBC who underwent intraventricular ICP monitoring had a shorter length of stay and lower medical expenses, had a lower rate of surgery and DC, and required lower doses of osmotic drugs, although there were no significant differences in 6-month outcomes in the patients with V-ICPM
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Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Jun-Hui Chen, Pei-Pei Li, and Li-Kun Yang are co–first authors.