Gupta et al. (2016)

India & USA

Cohort

N=400

Lele et al. (2018)

India

Secondary Analysis

N=200

Population: TBI=400. India (HPNATC) Site (n=200): Mean Age=36 yr; Gender: Male=169, Female=31. Mean ISS=31.4. USA (HMC) Site (n=200): Mean Age=44.1 yr; Gender: Male=145, Female= 55. Mean ISS=38.5.

Intervention: At HMC, 200 patients with TBI were retrospectively analyzed to asses the institution’s adherence to ICU TBI treatment guidelines. At HPNATC, 200 patients with TBI were prospectively analyzed to assess similar parameters. Outcomes were measured at 3, 6 and 12 mo post discharge.

Outcome Measures: In-Hospital Mortality, Glasgow Outcome Scale (GOS), Guideline Adherence.

Population: TBI=200.

ICP Monitor group (n=126): Mean Age=34.8 yr; Gender: Male=108, Female=18. No ICP Monitor group (n=74): Mean Age=38 yr; Gender: Male=60, Female=14.

Intervention: ICP monitor placement was retrospectively analyzed in patients with TBI. Those receiving an ICP monitor were compared to those without. Outcomes were assessed at discharge, 3, 6, and 12 mo post TBI.

Outcome Measures: In-Hospital Mortality, Glasgow Outcome Scale (GOS).

1.        At JPNATC, in-hospital mortality was 24%, compared to 24.3% at HMC.

2.        Guideline adherence rates were reported to be 74.9% at JPNATC, compared to a 71.6% rate at HMC.

3.        Highest adherence rates in both sites were found in: achieving target temperature, not using prophylactic barbiturates, starting of nutritional support and avoidance of IV steroids.

4.        At the JPNATC, a 1% increase in guideline adherence was associated with a 3% in-hospital mortality decrease [0.97; 95% CI, 0.95-0.99].

5.        Adherence rates below 65% were significantly associated with an increase in mortality [1.92; 95% CI, 1.11-3.33].

6.        At JPNATC, 60% of patients had improved GOS scores compared to discharge.

1.        In-hospital mortality was significantly lower in the ICP monitoring group when compared to the other group (0.50; 95%, 0.29-0.87).

2.        There was no significance difference in mortality (in-hospital) between groups at 3 (0.65; 95% CI, 0.40-1.05), 6 (0.70; 95% CI, 0.45-1.11), and 12mo (0.78; 95% CI, 0.51-1.18).

3.        There was no significance difference between groups in GOS scores at discharge (1.20; 95% CI, 0.58-2.49), 3 (0.87; 95% CI, 0.50-1.51), or 6 mo (0.99; 95% CI, 0.44-2.25).

4.        Amongst patients receiving ICP monitors, absence of cerebral edema (0.54; 95% CI, 0.35-0.84), and absence of IVH (0.53; 95%, CI, 0.33-0.82) were associated with the best outcomes.