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).

(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
Scientifica
CENTER-TBI; EVD; External ventricular devices; ICP; Intracranial hypertension; Intracranial pressure monitoring; Intraparenchymal monitors; Severe TBI; Traumatic brain injury;
English
VARGIOLU, ALESSIA on behalf of CENTER-TBI investigators, participants for the ICU stratum
(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: http://hdl.handle.net/10281/380528
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