@article {Ghneime000733, author = {Mira Ghneim and Jennifer Albrecht and Karen Brasel and Ariel Knight and Anna Liveris and Jill Watras and Christopher P Michetti and James Haan and Kelly Lightwine and Robert D Winfield and Sasha D Adams and Jeanette Podbielski and Scott Armen and J Christopher Zacko and Fady S Nasrallah and Kathryn B Schaffer and Julie A Dunn and Brittany Smoot and Thomas J Schroeppel and Zachery Stillman and Zara Cooper and Deborah M Stein}, editor = {, and , and Adams, Charles and Lueckel, Stephanie and Murry, Jason and Hsu, Cindy and Bhatti, Umer F. and Lissauer, Matthew E and LaFonte, Marc and Najafi, Kaveh and Lewandowski, Karen and Mukherjee, Kaushik and Imperio-Lagabon, Kristelle J. and Martin, Niels D. and Hirsch, Kathleen and Berry, Cherisse and Freitas, Derek and Cullinane, Daniel and Ramawani, Roshini and Truitt, Michael and Pearcy, Chris and Hashimi, Habiba and Kaups, Krista and Claridge, Jeffry and Ladhani, Husayn and Hartwell, Jennifer L. and Ballou, Jessica and Croce, Martin and Markle, Stephanie and Osserwaarde, Sally and Posluszny, Joseph and Stocker, Benjamin and Hranjec, Tjasa and Solomon, Rachele and Martinek, Lucy and Gupta, Alok and Grabo, Daniel J. and Khan, Uzer and Tatum, Danielle and Jacome, Tomas and Gates, Jonathan and Jawani, Alisha and Berndtson, Allison E. and Curry, Terry G. and Bala, Miklosh and Dultz, Linda A. and Houshmand, Natasha N. and Pieri, Paola and Zielinski, Martin D and Hughes, Joy D. and Hartwell, Jennifer and Malhotra, Ajai K. and Lee, Tim and Petrone, Patrizio and Joseph, D{\textquoteright}andrea and Marshall, Gary T. and Carrick, Matthew M. and Pathak, Abhijit and Zandt, Andrea Van and Glass, Nina and Livingston, David and Gregg, Shea and Webb, Travis and Drumheller, Byron and Kozar, Rosemary and Barraco, Robert and Joseph, Bellal}, title = {Factors associated with receipt of intracranial pressure monitoring in older adults with traumatic brain injury}, volume = {6}, number = {1}, elocation-id = {e000733}, year = {2021}, doi = {10.1136/tsaco-2021-000733}, publisher = {BMJ Specialist Journals}, abstract = {Background The Brain Trauma Foundation (BTF) Guidelines for the Management of Severe Traumatic Brain Injury (TBI) include intracranial pressure monitoring (ICPM), yet very little is known about ICPM in older adults. Our objectives were to characterize the utilization of ICPM in older adults and identify factors associated with ICPM in those who met the BTF guidelines.Methods We analyzed data from the American Association for the Surgery of Trauma Geriatric TBI Study, a registry study conducted among individuals with isolated, CT-confirmed TBI across 45 trauma centers. The analysis was restricted to those aged >=60. Independent factors associated with ICPM for those who did and did not meet the BTF guidelines were identified using logistic regression.Results Our sample was composed of 2303 patients, of whom 66 (2.9\%) underwent ICPM. Relative to Glasgow Coma Scale (GCS) score of 13 to 15, GCS score of 9 to 12 (OR 10.2; 95\% CI 4.3 to 24.4) and GCS score of \<9 (OR 15.0; 95\% CI 7.2 to 31.1), intraventricular hemorrhage (OR 2.4; 95\% CI 1.2 to 4.83), skull fractures (OR 3.6; 95\% CI 2.0 to 6.6), CT worsening (OR 3.3; 95\% CI 1.8 to 5.9), and neurosurgical interventions (OR 3.8; 95\% CI 2.1 to 7.0) were significantly associated with ICPM. Restricting to those who met the BTF guidelines, only 43 of 240 (18\%) underwent ICPM. Factors independently associated with ICPM included intraparenchymal hemorrhage (OR 2.2; 95\% CI 1.0 to 4.7), skull fractures (OR 3.9; 95\% CI 1.9 to 8.2), and neurosurgical interventions (OR 3.5; 95\% CI 1.7 to 7.2).Discussion Worsening GCS, intraparenchymal/intraventricular hemorrhage, and skull fractures were associated with ICPM among older adults with TBI, yet utilization of ICPM remains low, especially among those meeting the BTF guidelines, and potential benefits remain unclear. This study highlights the need for better understanding of factors that influence compliance with BTF guidelines and the risks versus benefits of ICPM in this population.Level of evidence Prognostic and epidemiological, level III.No data are available.}, URL = {http://tsaco.smart01.highwire.org/content/6/1/e000733}, eprint = {http://tsaco.smart01.highwire.org/content/6/1/e000733.full.pdf}, journal = {Trauma Surgery \& Acute Care Open} }