Factors influencing the decision to monitor intracranial pressure in traumatic brain injury. A large monocentric study

Introduction: The blurry indications on Intracranial pressure (ICP) monitoring in patients with Traumatic Brain Injury (TBI) causes differences in the clinical practice among different centers [1, 2]. Aim of this study is to assess the main factors that guided the decision making of monitoring ICP in TBI patients in our institution. Methods: This is a retrospective, observational study including adult TBI patients admitted to the Neuro Intensive Care Unit (NICU) at S. Gerardo Hospital, Monza, from 1997 to 2016 [3]. Univariate logistic regression analyses were performed to identify predictors associated with the decision for ICP monitoring. Results: A total of 857 adult patients were included (Tables 1 and 2). The risk of poor outcome estimated by the IMPACT model was associated to the decision to monitor ICP (Fig. 1). ICP was more often monitored in patients with severe TBI, with one dilated pupil at admission and positive CT findings (in particular, high Marshall scores). Conclusions: According to our results, the clinician follows a multifactorial reasoning: the main determinants for the decision to monitor ICP are GCS, pupils’ abnormalities and, above all, CT findings. Future studies will be needed to clarify specific indications for the clinicians in the identification of patients who would benefit from invasive monitoring.