Perceived Utility of Intracranial Pressure Monitoring in Traumatic Brain Injury: A Seattle International Brain Injury Consensus Conference Consensus-Based Analysis and Recommendations

Neurosurgery, 2023 · DOI: https://doi.org/10.1227/neu.0000000000002516 · Published: August 1, 2023

Simple Explanation

This study examines how experienced brain injury specialists decide when to use intracranial pressure (ICP) monitors. The goal is to understand if these experts follow current guidelines and to provide practical advice for doctors considering using these monitors. The panel members were polled on their 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). The results showed that ICP monitors are used more often than current guidelines suggest. Clinical examination (GCS) was the most important factor in deciding to use a monitor, followed by CT scan results and pupillary examination.

Study Duration

October 08, 2020 to December 10, 2020

Participants

42 Seattle International Brain Injury Consensus Conference panel members

Evidence Level

Consensus-Based Analysis and Recommendations

Key Findings

1
ICP monitor use is wider than predicted by guidelines.
2
Clinical examination (GCS) was the most important factor in decision-making and differed from guidelines in being nonlinear.
3
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.

Research Summary

This study investigated the perceived utility of intracranial pressure (ICP) monitoring among experienced neurotraumatologists. The study used a consensus-based approach, polling members of the Seattle International Brain Injury Consensus Conference (SIBICC) on their ICP monitoring decisions for virtual patients. The findings suggest that ICP monitoring is considered valuable in a broader spectrum of patients with TBI than current guidelines recommend. Clinical examination (GCS), CT scan findings, and pupillary examination were key determinants in the decision-making process. The study provides consensus-based insertion heatmaps and recommendations for use in clinical decision-making and in analyzing survey-based ICP monitoring efficacy studies. These resources are intended to assist clinicians in making informed decisions about ICP monitor insertion.

Practical Implications

Informed Decision-Making

The heatmaps and recommendations can aid clinicians, especially those with limited TBI experience, in making informed decisions about ICP monitor insertion.

Research Implications

The findings can inform the design and analysis of survey-based ICP monitoring efficacy studies by highlighting variables relevant to the monitoring decision.

Guideline Refinement

The study suggests a need to re-evaluate and potentially broaden current ICP monitoring guidelines to better reflect the perceived utility of ICP data among experienced clinicians.

Study Limitations

1
The artificial nature of the exercise may not fully capture the complexities of real-world clinical decision-making.
2
The study does not account for all factors that may influence monitoring decisions, such as age, history of hypotension or hypoxia, and severe extracranial trauma.
3
The hypothetical nature of the exercise may not necessarily reflect the panelist’s actual real-world behavior.

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