Effect of intracranial pressure monitoring and aggressive treatment on mortality in severe head injury

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  • 1 Division of Neurological Surgery, University of Maryland School of Medicine, Baltimore, Maryland
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✓ During 1977–1978, 127 patients with severe head injury were admitted and underwent intracranial pressure (ICP) monitoring. All patients had Glasgow Coma Scale (GCS) scores of 7 or less. All received identical initial treatment according to a standardized protocol. The patients' average age was 29 years; 60% had multiple trauma, and 35% needed emergency intracranial operations. Treatment for elevations of ICP was begun when ICP rose to 20 to 25 mm Hg, and included mannitol therapy and drainage of cerebrospinal fluid (CSF) when possible. Forty-three patients (34%) had ICP greater than or equal to 25 mm Hg; of these, 36 (84%) died. The mortality rate of the entire group was 46%.

During 1979–1980, 106 patients with severe head injury were admitted and underwent ICP monitoring. Their average age was 29 years; 51% had multiple trauma, and 31% underwent emergency intracranial surgery. All patients received the same standardized protocol as the previous series, with the exception of the treatment of ICP. In this present series: if ICP was 15 mm Hg or less (normal ICP), patients were continued on hyperventilation, steroids, and intensive care; if ICP was 16 to 24 mm Hg, mannitol was administered and CSF was drained; if ICP was 25 mm Hg or greater, the patients were randomized into a controlled barbiturate therapy study. Twenty-six patients (25%) had ICP's of 25 mm Hg or greater, compared to 34% in the previous series (p < 0.05), and 18 of these 26 patients (69%) died. The overall mortality for this current series was 28% compared to 46% in the previous series (p < 0.0005).

This study reconfirms the high mortality rate if ICP is 25 mm Hg or greater; however, the data also document that early aggressive treatment based on ICP monitoring significantly lessens the incidence of ICP of 25 mm Hg or greater and reduces the overall mortality rate of severe head injury.

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Contributor Notes

Address reprint requests to: Thomas G. Saul, M.D., Mayfield Neurological Institute of Cincinnati, Inc., 506 Oak Street, Cincinnati, Ohio 45219.
  • 1.

    Auer L, , Oberbauer R, & Tritthart H, et al: Relevance of cat-scan for the level of ICP in patients with severe head injury, in Shulman K, , Marmarou A, & Miller JD, et al (eds): Intracranial Pressure IV. Berlin: Springer-Verlag, 1980, pp 4547 Auer L, Oberbauer R, Tritthart H, et al: Relevance of cat-scan for the level of ICP in patients with severe head injury, in Shulman K, Marmarou A, Miller JD, et al (eds): Intracranial Pressure IV. Berlin: Springer-Verlag, 1980, pp 45–47

    • Search Google Scholar
    • Export Citation
  • 2.

    Becker DP, , Miller JD, & Ward JD, et al: The outcome from severe head injury with early diagnosis and intensive management. J Neurosurg 47:491502, 1977 Becker DP, Miller JD, Ward JD, et al: The outcome from severe head injury with early diagnosis and intensive management. J Neurosurg 47:491–502, 1977

    • Search Google Scholar
    • Export Citation
  • 3.

    Bowers SA, & Marshall LF: Outcome in 200 consecutive cases of severe head injury treated in San Diego County: a prospective analysis. Neurosurgery 6:237242, 1980 Bowers SA, Marshall LF: Outcome in 200 consecutive cases of severe head injury treated in San Diego County: a prospective analysis. Neurosurgery 6:237–242, 1980

    • Search Google Scholar
    • Export Citation
  • 4.

    Bruce DA, , Gennarelli TA, & Langfitt TW: Resuscitation from coma due to head injury. Crit Care Med 6:254269, 1978 Bruce DA, Gennarelli TA, Langfitt TW: Resuscitation from coma due to head injury. Crit Care Med 6:254–269, 1978

    • Search Google Scholar
    • Export Citation
  • 5.

    Bruce DA, , Schut L, & Bruno LA, et al: Outcome following severe head injuries in children. J Neurosurg 48:679688, 1978 Bruce DA, Schut L, Bruno LA, et al: Outcome following severe head injuries in children. J Neurosurg 48:679–688, 1978

    • Search Google Scholar
    • Export Citation
  • 6.

    Byrnes DP, & Ducker TB: Continuous measurement of intracranial pressure in 127 severe head injuries, in Shulman K, , Marmarou A, & Miller JD, et al (eds): Intracranial Pressure IV. Berlin: Springer-Verlag, 1980, pp 7378 Byrnes DP, Ducker TB: Continuous measurement of intracranial pressure in 127 severe head injuries, in Shulman K, Marmarou A, Miller JD, et al (eds): Intracranial Pressure IV. Berlin: Springer-Verlag, 1980, pp 73–78

    • Search Google Scholar
    • Export Citation
  • 7.

    Haar FL, , Sabher VK, & Gildenberg PL, et al: Can CT scan findings predict ICP in closed head injury patients? Presented at the 30th Annual Meeting of the Congress of Neurological Surgeons, Houston, October, 1980 Haar FL, Sabher VK, Gildenberg PL, et al: Can CT scan findings predict ICP in closed head injury patients? Presented at the 30th Annual Meeting of the Congress of Neurological Surgeons, Houston, October, 1980

    • Search Google Scholar
    • Export Citation
  • 8.

    Jennett B, & Bond M: Assessment of outcome after severe brain damage. A practical scale. Lancet 1:480484, 1975 Jennett B, Bond M: Assessment of outcome after severe brain damage. A practical scale. Lancet 1:480–484, 1975

    • Search Google Scholar
    • Export Citation
  • 9.

    Lundberg N: Continuous recording and control of ventricular fluid pressure in neurosurgical practice. Acta Psychiatr Neurol Scand 36 ( Suppl 149): 1193, 1960 Lundberg N: Continuous recording and control of ventricular fluid pressure in neurosurgical practice. Acta Psychiatr Neurol Scand 36 (Suppl 149):1–193, 1960

    • Search Google Scholar
    • Export Citation
  • 10.

    Marshall LF, , Smith RW, & Shapiro HM: The outcome with aggressive treatment in severe head injuries. Part I: The significance of intracranial pressure monitoring. J Neurosurg 50:2025, 1979 Marshall LF, Smith RW, Shapiro HM: The outcome with aggressive treatment in severe head injuries. Part I: The significance of intracranial pressure monitoring. J Neurosurg 50:20–25, 1979

    • Search Google Scholar
    • Export Citation
  • 11.

    Miller JD, , Becker DP, & Ward JD, et al: Significance of intracranial hypertension in severe head injury. J Neurosurg 47:503516, 1977 Miller JD, Becker DP, Ward JD, et al: Significance of intracranial hypertension in severe head injury. J Neurosurg 47:503–516, 1977

    • Search Google Scholar
    • Export Citation
  • 12.

    Miller JD, , Butterworth JF, & Gudeman SK, et al: Further experience in the management of severe head injury. J Neurosurg 54:289299, 1981 Miller JD, Butterworth JF, Gudeman SK, et al: Further experience in the management of severe head injury. J Neurosurg 54:289–299, 1981

    • Search Google Scholar
    • Export Citation
  • 13.

    Saul TG, & Ducker TB: Management of severe head injuries. Md State Med J (In press, 1981)Saul TG, Ducker TB: Management of severe head injuries. Md State Med J (In press, 1981)

    • Search Google Scholar
    • Export Citation
  • 14.

    Saul TG, , Ducker TB, & Salcman M, et al: Steroids in severe head injury. A prospective randomized clinical trial. J Neurosurg 54:596600, 1981 Saul TG, Ducker TB, Salcman M, et al: Steroids in severe head injury. A prospective randomized clinical trial. J Neurosurg 54:596–600, 1981

    • Search Google Scholar
    • Export Citation

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