The Impact of a Protocolization Approach to Increase the Use of and Timeliness to Intracranial Pressure Monitoring in Patients With Severe Traumatic Brain Injury at a Level 1 Trauma Center

Abstract

While there is agreement on the indications for intracranial pressure monitoring (ICPm) in patients with sTBI, there continues to be controversy concerning the ideal timing of its implementation. It is within this context that we decided to investigate whether a protocolization approach could optimize the timeliness of ICPm implementation. Neurosurgical and SICU providers agreed to a 3-tier protocol to identify patients with sTBI who could benefit from timelier ICPm implementation. The monthly compliance was monitored for a 9-month period. The study included a pre-protocolization group of 11 patients (2022) and a post-protocolization group of 9 patients (2023-2024). There was a trend toward earlier use of ICPm but the difference did not achieve statistical significance; there was no difference in the mortality rates between groups. A protocolization approach to the treatment of patients with sTBI developed with a consensus strategy may lead to earlier implementation of ICPm and possibly improved functional outcome.

Keywords

intracranial pressure monitoring severe traumatic brain injury protocol

Get full access to this article

View all access options for this article.

References

Cnossen

Huijben

van der Jagt

CENTER-TBI investigators , et al.. Variation in monitoring and treatment policies for intracranial hypertension in traumatic brain injury: a survey in 66 neurotrauma centers participating in the CENTER-TBI study. Crit Care. 2017;21:233. doi:10.1186/s13054-017-1816-9

Hawryluk

GWJ

Aguilera

Buki

, et al. A management algorithm for patients with intracranial pressure monitoring: the Seattle International Severe Traumatic Brain Injury Consensus Conference (SIBICC). Intensive Care Med. 2019;45:1783-1794. doi:10.1007/s00134-019-05805-9

Marini

McNelis

Petrone

. Multimodality monitoring and goal-directed therapy for the treatment of patients with severe traumatic brain injury: a review for the general and trauma surgeon. Curr Probl Surg. 2022;59(4):101070. doi:10.1016/j.cpsurg.2021.101070

Chestnut

Temkin

Videtta

Petroni

, et al. Consensus-based Management Protocol (CREVICE protocol) for the treatment of severe traumatic brain injury based on imaging and clinical examination for use when intracranial pressure monitoring is not employed. J Neurotrauma. 2020;37(11):1291-1299. doi:10.1089/neu.2017.5599