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J Neurosurg. 2019 May 31:1-11. doi: 10.3171/2019.3.JNS19545. [Epub ahead of print]

Intracranial pressure monitoring in patients with spontaneous intracerebral hemorrhage.

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Departments of1Neurological Surgery.
2Department of Neurosurgery, University of Louisville, Louisville, Kentucky.
3Department of Neurosurgery, NewYork-Presbyterian/Columbia University Medical Center, New York, New York.
4Neurology, and.
5Public Health Sciences, University of Virginia, Charlottesville, Virginia.
6Department of Neurology, University of Illinois, Chicago, Illinois; and.
7Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, Ohio.


OBJECTIVEThe utility of ICP monitoring and its benefit with respect to outcomes after ICH is unknown. The aim of this study was to compare intracerebral hemorrhage (ICH) outcomes in patients who underwent intracranial pressure (ICP) monitoring to those who were managed by care-guided imaging and/or clinical examination alone.METHODSThis was a retrospective analysis of data from the Ethnic/Racial variations of Intracerebral Hemorrhage (ERICH) study between 2010 and 2015. ICH patients who underwent ICP monitoring were propensity-score matched, in a 1:1 ratio, to those who did not undergo ICP monitoring. The primary outcome was 90-day mortality. Secondary outcomes were in-hospital mortality, hyperosmolar therapy use, ICH evacuation, length of hospital stay, and 90-day modified Rankin Scale (mRS) score, excellent outcome (mRS score 0-1), good outcome (mRS score 0-2), Barthel Index, and health-related quality of life (HRQoL; measured by EQ-5D and EQ-5D visual analog scale [VAS] scores). A secondary analysis for patients without intraventricular hemorrhage was performed.RESULTSThe ICP and no ICP monitoring cohorts comprised 566 and 2434 patients, respectively. The matched cohorts comprised 420 patients each. The 90-day and in-hospital mortality rates were similar between the matched cohorts. Shift analysis of 90-day mRS favored no ICP monitoring (p < 0.001). The rates of excellent (p < 0.001) and good (p < 0.001) outcome, Barthel Index (p < 0.001), EQ-5D score (p = 0.026), and EQ-5D VAS score (p = 0.004) at 90 days were lower in the matched ICP monitoring cohort. Rates of mannitol use (p < 0.001), hypertonic saline use (p < 0.001), ICH evacuation (p < 0.001), and infection (p = 0.001) were higher, and length of hospital stay (p < 0.001) was longer in the matched ICP monitoring cohort. In the secondary analysis, the matched cohorts comprised 111 patients each. ICP monitoring had a lower rate of 90-day mortality (p = 0.041). Shift analysis of 90-day mRS, Barthel Index, and HRQoL metrics were comparable between the matched cohorts.CONCLUSIONSThe findings of this study do not support the routine utilization of ICP monitoring in patients with ICH.


ERICH = Ethnic/Racial variations of Intracerebral Hemorrhage; GCS = Glasgow Coma Scale; HRQoL = health-related quality of life; ICH = intracerebral hemorrhage; ICP = intracranial pressure; IVH = intraventricular hemorrhage; OR = odds ratio; RR = rate ratio; TBI = traumatic brain injury; VAS = visual analog scale; aOR = adjusted odds ratio; aβ = adjusted β; bleed; intracerebral hemorrhage; intracranial pressure; mRS = modified Rankin Scale; monitor; outcome; stroke; vascular disorders


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