Intracranial Pressure Monitor Insertion in Isolated Traumatic Brain Injury: Does Timing Matter?

Background Intracranial pressure monitoring (ICPM) is recommended in selected patients with severe traumatic brain injury (sTBI). Optimal timing of ICPM insertion after sTBI is not well studied. We aimed to evaluate if timing of ICPM insertion would impact outcomes. Materials and Methods We utilized data from 2018 to 2021 from the American College of Surgeons Trauma Quality Improvement Program. Patients ≥16 years from level 1 and 2 trauma centers with isolated blunt sTBI were included. Nonsurvivable brain injury (AIS-head = 6) and those needing emergent open cranial (OC) procedures within 2 hours of admission were excluded. Timing of ICPM insertion was categorized as follows: no ICPM insertion, ≤4 h, >4 to ≤12 h, and >12 h. Binary logistic regression analysis was used to assess variables associated with mortality. Results 17 715 patients were included. 2525 (14%) had ICPM placed, 2613 (15%) underwent open cranial surgery, and 8757 (49%) died. There was no ICPM insertion in 86% while 8%, 4%, and 2% underwent ICPM insertion ≤4 h, >4 to ≤12 h, and >12 h, respectively. Compared to no ICPM, insertion ≤4 h (odds ratio [OR] 0.94 [0.82-1.09]), >4 to ≤12 h (OR 1.18 [0.97-1.43]), and >12 h (OR 1.02 [0.81-1.31]), respectively, were not associated with mortality. Open cranial procedure was associated with reduced risk of death (OR 0.40 [0.36-0.45]). Discussion For blunt isolated sTBI, Timing of ICPM insertion was not associated with mortality reduction. Early ICPM insertion may be less important than expeditious OC.