HCPLive Network

Care Based on Intracranial Pressure Not Superior in Traumatic Brain Injury

 
WEDNESDAY, Dec. 12 (HealthDay News) -- For patients with severe traumatic brain injury (TBI) treated in the intensive care unit, treatment based on maintaining monitored intracranial pressure is not superior to care based on imaging and clinical examination, according to a study published online Dec. 12 in the New England Journal of Medicine.

Randall M. Chesnut, M.D., from the University of Washington in Seattle, and colleagues conducted a multicenter trial involving 324 patients aged 13 years or older with severe TBI. The participants were randomly allocated to receive guidelines-based management, in which a protocol for monitoring intraparenchymal intracranial pressure was used, or a treatment protocol based on imaging and clinical examination.

The researchers observed no significant difference between the groups in the primary outcome, a composite measure based on 21 assessments of functional and cognitive status, and six-month mortality was also not significantly different between the groups (P = 0.60). There was no significant difference in the median length of stay in the intensive care unit between the groups, although the imaging-clinical examination group had a higher number of days of brain-specific treatments (4.8 versus 3.4; P = 0.002). There was a similar distribution of serious adverse events between the groups.

"Our data suggest that a reassessment of the role of manipulating monitored intracranial pressure as part of multimodality monitoring and targeted treatment of severe traumatic brain injury is in order," the authors write.

The study was funded in part by Integra Life Sciences; all of the study authors disclosed financial ties to Integra Life Sciences as well as to two personal injury law firms.
 

Abstract
Full Text
Editorial

 
Copyright © 2012 HealthDay. All rights reserved.
 
 

Further Reading
Avoiding intracranial hemorrhage (ICH) is a major concern for physicians treating patients with anticoagulation drugs. Iatrogenic ICH related to anticoagulants occurs in 0.3% to 1.8% of patients a year who are taking warfarin.
Cerebral microbleeds (CMBs) following a transient ischemic attack (TIA) may be a sign a patient is likely to have another stroke. All patients who have a TIA are at risk of a recurrence, but that risk can be modified by optimal treatment, Jae-Sung Lim, MD, MSc and colleagues report. In fact, 80% of those recurrences could be eliminated, Lim wrote in a study in JAMA Neurology. But that may not be the case with TIA patients who have CMBs
As a blizzard predicted to break snowfall records bears down upon the Northeast, hospitals and physicians are shifting into disaster-planning mode. With the worst of the blizzard expected to hit coastal New England, Mass. Gov. Charlie Baker has declared a state of emergency and instituted a travel ban that will take effect at midnight. , per Boston.com. Shriner’s Hospital in Boston canceled elective procedures and clinic visits. New Jersey Gov. Chris Christie declared a state of emergency at noon Monday, closing state offices and urging motorists to stay off the roads. In a news conference this afternoon, he said the state’s emergency workers and transportation department can handle the storm.
More Reading