LAUSR

OBJECTIVE While intracranial pressure-guided therapy has been the mainstay of treatment of patients with severe traumatic brain injury (TBI), recent data has questioned its efficacy. Our goal is to demonstrate the trends in compliance to the TBI guidelines and use of ICP-guided care in a mature trauma system. METHODS We conducted a retrospective analysis of 36,915 patients with severe TBI collected by the Pennsylvania Trauma Systems Foundation. The registry includes all patients greater than 18 years old with a diagnosis of TBI with a GCS of 8 or lower that were admitted from January 2000 to December 2017. RESULTS Of the 36,915 patients, 73.6% were males with median age of 43.0±21.3 years old. An ICP monitor was placed in 16.3% of all patients. The rate of ICP monitoring ranged from 17.8% of patients in 2000-2004 to 16.7% in 2005-2009, 16.4% in 2010-2014, and declined to 12.8% from 2015-2017 (p<0.001). The most statistically significant decrease was noted from 2014 (16.4%) to 2015 (14.1%, p=0.042). The percent decrease in ICP monitoring from 2000-14 to 2015-17 was equivalent for patients with GCS scores of 3-5 (- 4.0%) and GCS 6-8 (- 4.5%). CONCLUSION As studies emerged that demonstrated unclear benefit of ICP monitoring in improving care in patients with severe TBI, there was a significant statewide decline in the utilization of ICP monitoring after 2014 among all TBI subpopulations despite noteworthy limitations in the aforementioned studies and clear recommendations from the BTF guidelines.