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Meta-Analysis
. 2016 Dec 28;11(12):e0168901.
doi: 10.1371/journal.pone.0168901. eCollection 2016.

Effects of Intracranial Pressure Monitoring on Mortality in Patients with Severe Traumatic Brain Injury: A Meta-Analysis

Liang Shen  1 , Zhuo Wang  2 , Zhongzhou Su  1 , Sheng Qiu  1 , Jie Xu  1 , Yue Zhou  1 , Ai Yan  1 , Rui Yin  1 , Bin Lu  1 , Xiaohu Nie  1 , Shufa Zhao  1 , Renfu Yan  1
Affiliations
Meta-Analysis

Effects of Intracranial Pressure Monitoring on Mortality in Patients with Severe Traumatic Brain Injury: A Meta-Analysis

Liang Shen et al. PLoS One. .

Abstract

Background: The Brain Trauma Foundation (BTF) guidelines published in 2007 suggest some indications for intracranial pressure (ICP) monitoring in severe traumatic brain injury (TBI). However, some studies had not shown clinical benefit in patients with severe TBI; several studies had even reported that ICP monitoring was associated with an increased mortality rate. The effect of ICP monitoring has remained controversial, regardless of the ICP monitoring guidelines. Here we performed a meta-analysis of published studies to assess the effects of ICP monitoring in patients with severe TBI.

Methods: We searched three comprehensive databases, the Cochrane Library, PUBMED, and EMBASE, for studies without limitations published up to September 2015. Mortality, ICU LOS, and hospital LOS were analyzed with Review Manager software according to data from the included studies.

Results: Eighteen eligible studies involving 25229 patients with severe TBI were included in our meta-analysis. The results indicated no significant reduction in the ICP monitored group in mortality (hospitalized before 2007), hospital mortality (hospitalized before 2007), mortality in randomized controlled trials. However, overall mortality, mortality (hospitalized after 2007), hospital mortality (hospitalized after 2007), mortality in observational studies (hospitalized after 2007), 2-week mortality, 6-month mortality, were reduced in ICP monitored group. Patients with an increased ICP were more likely to require ICP monitoring.

Conclusion: Superior survival was observed in severe TBI patients with ICP monitoring since the third edition of "Guidelines for the Management of Severe Traumatic Brain Injury," which included "Indications for intracranial pressure monitoring," was published in 2007.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flow diagram of literature search and selection process.
Fig 2
Fig 2. Effect of ICP monitoring on overall mortality among patients with severe TBI.
Fig 3
Fig 3. Forest plot of association between ICP monitoring and mortality in patients with severe TBI stratified by hospitalized time.
Fig 4
Fig 4. Forest plot of association between ICP monitoring and mortality in ICU mortality and in-hospital mortality.
Fig 5
Fig 5. Forest plot of association between ICP monitoring and mortality in only RCTs, observational studies, and child populations.
Fig 6
Fig 6. Forest plot of association between ICP monitoring and mortality expressed as 2-week and 6-month mortality rates.
Fig 7
Fig 7. Funnel plot of publication bias of all included studies of mortality.
See this image and copyright information in PMC

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