Objective: To compare outcomes between patients with primary external ventricular device (EVD)–driven treatment of intracranial hypertension and those with primary intraparenchymal monitor (IP)–driven treatment. Methods: The CENTER-TBI study is a prospective, multicenter, longitudinal observational cohort study that enrolled patients of all TBI severities from 62 participating centers (mainly level I trauma centers) across Europe between 2015 and 2017. Functional outcome was assessed at 6 months and a year. We used multivariable adjusted instrumental variable (IV) analysis with “center” as instrument and logistic regression with covariate adjustment to determine the effect estimate of EVD on 6-month functional outcome. Results: A total of 878 patients of all TBI severities with an indication for intracranial pressure (ICP) monitoring were included in the present study, of whom 739 (84%) patients had an IP monitor and 139 (16%) an EVD. Patients included were predominantly male (74% in the IP monitor and 76% in the EVD group), with a median age of 46 years in the IP group and 48 in the EVD group. Six-month GOS-E was similar between IP and EVD patients (adjusted odds ratio (aOR) and 95% confidence interval [CI] OR 0.74 and 95% CI [0.36–1.52], adjusted IV analysis). The length of intensive care unit stay was greater in the EVD group than in the IP group (adjusted rate ratio [95% CI] 1.70 [1.34–2.12], IV analysis). One hundred eighty-seven of the 739 patients in the IP group (25%) required an EVD due to refractory ICPs. Conclusion: We found no major differences in outcomes of patients with TBI when comparing EVD-guided and IP monitor–guided ICP management. In our cohort, a quarter of patients that initially received an IP monitor required an EVD later for ICP control. The prevalence of complications was higher in the EVD group. Protocol: The core study is registered with ClinicalTrials.gov, number NCT02210221, and the Resource Identification Portal (RRID: SCR_015582).

Volovici, V., Pisică, D., Gravesteijn, B., Dirven, C., Steyerberg, E., Ercole, A., et al. (2022). Comparative effectiveness of intracranial hypertension management guided by ventricular versus intraparenchymal pressure monitoring: a CENTER-TBI study. ACTA NEUROCHIRURGICA, 164(7), 1693-1705 [10.1007/s00701-022-05257-z].

Comparative effectiveness of intracranial hypertension management guided by ventricular versus intraparenchymal pressure monitoring: a CENTER-TBI study

Citerio, Giuseppe;Vargiolu, Alessia
Membro del Collaboration Group
;
2022

Abstract

Objective: To compare outcomes between patients with primary external ventricular device (EVD)–driven treatment of intracranial hypertension and those with primary intraparenchymal monitor (IP)–driven treatment. Methods: The CENTER-TBI study is a prospective, multicenter, longitudinal observational cohort study that enrolled patients of all TBI severities from 62 participating centers (mainly level I trauma centers) across Europe between 2015 and 2017. Functional outcome was assessed at 6 months and a year. We used multivariable adjusted instrumental variable (IV) analysis with “center” as instrument and logistic regression with covariate adjustment to determine the effect estimate of EVD on 6-month functional outcome. Results: A total of 878 patients of all TBI severities with an indication for intracranial pressure (ICP) monitoring were included in the present study, of whom 739 (84%) patients had an IP monitor and 139 (16%) an EVD. Patients included were predominantly male (74% in the IP monitor and 76% in the EVD group), with a median age of 46 years in the IP group and 48 in the EVD group. Six-month GOS-E was similar between IP and EVD patients (adjusted odds ratio (aOR) and 95% confidence interval [CI] OR 0.74 and 95% CI [0.36–1.52], adjusted IV analysis). The length of intensive care unit stay was greater in the EVD group than in the IP group (adjusted rate ratio [95% CI] 1.70 [1.34–2.12], IV analysis). One hundred eighty-seven of the 739 patients in the IP group (25%) required an EVD due to refractory ICPs. Conclusion: We found no major differences in outcomes of patients with TBI when comparing EVD-guided and IP monitor–guided ICP management. In our cohort, a quarter of patients that initially received an IP monitor required an EVD later for ICP control. The prevalence of complications was higher in the EVD group. Protocol: The core study is registered with ClinicalTrials.gov, number NCT02210221, and the Resource Identification Portal (RRID: SCR_015582).
Articolo in rivista - Articolo scientifico
CENTER-TBI; EVD; External ventricular devices; ICP; Intracranial hypertension; Intracranial pressure monitoring; Intraparenchymal monitors; Severe TBI; Traumatic brain injury;
English
1693
1705
13
VARGIOLU, ALESSIA on behalf of CENTER-TBI investigators, participants for the ICU stratum
Volovici, V., Pisică, D., Gravesteijn, B., Dirven, C., Steyerberg, E., Ercole, A., et al. (2022). Comparative effectiveness of intracranial hypertension management guided by ventricular versus intraparenchymal pressure monitoring: a CENTER-TBI study. ACTA NEUROCHIRURGICA, 164(7), 1693-1705 [10.1007/s00701-022-05257-z].
Volovici, V; Pisică, D; Gravesteijn, B; Dirven, C; Steyerberg, E; Ercole, A; Stocchetti, N; Nelson, D; Menon, D; Citerio, G; van der Jagt, M; Maas, A; Haitsma, I; Lingsma, H; Åkerlund, C; Amrein, K; Andelic, N; Andreassen, L; Audibert, G; Azouvi, P; Azzolini, M; Bartels, R; Beer, R; Bellander, B; Benali, H; Berardino, M; Beretta, L; Beqiri, E; Blaabjerg, M; Lund, S; Brorsson, C; Buki, A; Cabeleira, M; Caccioppola, A; Calappi, E; Calvi, M; Cameron, P; Lozano, G; Castaño-León, A; Cavallo, S; Chevallard, G; Chieregato, A; Coburn, M; Coles, J; Cooper, J; Correia, M; Czeiter, E; Czosnyka, M; Dahyot-Fizelier, C; Dark, P; De Keyser, V; Degos, V; Corte, F; Boogert, H; Depreitere, B; Dilvesi, D; Dixit, A; Dreier, J; Dulière, G; Ezer, E; Fabricius, M; Foks, K; Frisvold, S; Furmanov, A; Galanaud, D; Gantner, D; Ghuysen, A; Giga, L; Golubovic, J; Gomez, P; Grossi, F; Gupta, D; Haitsma, I; Helseth, E; Hutchinson, P; Jankowski, S; Johnson, F; Karan, M; Kolias, A; Kondziella, D; Koraropoulos, E; Koskinen, L; Kovács, N; Kowark, A; Lagares, A; Laureys, S; Ledoux, D; Lejeune, A; Lightfoot, R; Manara, A; Martino, C; Maréchal, H; Mattern, J; Mcmahon, C; Menovsky, T; Misset, B; Muraleedharan, V; Murray, L; Negru, A; Newcombe, V; Nyirádi, J; Ortolano, F; Payen, J; Perlbarg, V; Persona, P; Piippo-Karjalainen, A; Ples, H; Pomposo, I; Posti, J; Puybasset, L; Radoi, A; Ragauskas, A; Raj, R; Rhodes, J; Richter, S; Rocka, S; Roe, C; Roise, O; Rosenfeld, J; Rosenlund, C; Rosenthal, G; Rossaint, R; Rossi, S; Sahuquillo, J; Sandrød, O; Sakowitz, O; Sanchez-Porras, R; Schirmer-Mikalsen, K; Schou, R; Smielewski, P; Sorinola, A; Stamatakis, E; Sundström, N; Takala, R; Tamás, V; Tamosuitis, T; Tenovuo, O; Thomas, M; Tibboel, D; Tolias, C; Trapani, T; Tudora, C; Vajkoczy, P; Vallance, S; Valeinis, E; Vámos, Z; Van der Steen, G; van Wijk, R; Vargiolu, A; Vega, E; Vik, A; Vilcinis, R; Vulekovic, P; Williams, G; Winzeck, S; Wolf, S; Younsi, A; Zeiler, F; Ziverte, A; Clusmann, H; Voormolen, D; van , ; Dijck, J; van Essen, T
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/10281/380528
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