UMEM Educational Pearls

Management of patients with severe traumatic brain injury (TBI) typically involves the use of invasive intra-parenchymal pressure monitors. Although use of these monitors is recommended by TBI management guidelines, good quality evidence of benefit is lacking.

A recently published study evaluated the outcomes of TBI patients using a management protocol incorporating either an intracranial pressure (ICP) monitor compared to use of the clinical exam PLUS serial neuroimaging; a total of 324 patients were prospectively randomized into either group.

The primary study outcome was a composite of survival, impaired consciousness, and functional status at both three and six months.

The results of the study did not show a significant difference in the:

  • Primary outcome  
  • Median length of ICU stay
  • Distribution of serious adverse events

Bottom line: This study suggests that clinical exam PLUS serial neuroimaging may perform as well as invasive intra-parenchymal monitors for guiding therapy in TBI patients.


Chestnut, R. et al.  A Trial of Intracranial-Pressure Monitoring in Traumatic Brain Injury. NEJM 2012 Dec 12.

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