Intracranial pressure monitors associated with increased venous thromboembolism in severe traumatic brain injury.

European Journal of Trauma and Emergency Surgery : Official Publication of the European Trauma Society
Angela AllenJeffry Nahmias

Abstract

Utilization of intracranial pressure monitors (ICPMs) has not been consistently shown to improve mortality in patients with severe traumatic brain injury (TBI). A single-center analysis concluded that venous thromboembolism (VTE) chemoprophylaxis (CP) posed no significant bleeding risk in patients following ICPM implementation; however, there is still debate about the optimal use and timing of CP in patients with ICPMs for fear of worsening intracranial hemorrhage. We hypothesized that ICPM use is associated with increased time to VTE CP and thus increased VTE in patients with severe TBI. A retrospective analysis of the Trauma Quality Improvement Program (2010-2016) was performed to compare severe TBI patients with and without ICPMs. A multivariable logistic regression analysis was completed. From 35,673 patients with severe TBI, 12,487 (35%) had an ICPM. Those with ICPMs had a higher rate of VTE CP (64.3% vs. 49.4%, p < 0.001) but a longer median time to CP initiation (5 vs. 4 days, p < 0.001) as well as a longer hospital length of stay (LOS) (18 vs. 9 days, p < 0.001) compared to those without ICPMs. After adjusting for covariates, ICPM use was found to be associated with a higher risk of VTE (9.2% vs 4.3%, OR = 1.75, CI = 1....Continue Reading

References

Dec 15, 1994·The New England Journal of Medicine·W H GeertsJ P Szalai
Feb 27, 2007·American Journal of Surgery·Kent DensonRoxie Albrecht
Mar 26, 2009·The New England Journal of Medicine·Simon FinferJuan J Ronco
Sep 23, 2016·Neurosurgery·Nancy CarneyJamshid Ghajar
Apr 21, 2017·The Journal of Trauma and Acute Care Surgery·Benjamin N JacobsMark R Hemmila

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Brain Injury & Trauma

brain injury after impact to the head is due to both immediate mechanical effects and delayed responses of neural tissues.

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