• Walter Mauritz, Heinz Steltzer, Peter Bauer, Lorenz Dolanski-Aghamanoukjan, and Philipp Metnitz.
• Department of Anaesthesia and Critical Care Medicine, Trauma Hospital Lorenz Boehler, Donaueschingenstrasse 13, 1200, Vienna, Austria. walter.mauritz@auva.at
• Intensive Care Med. 2008 Jul 1;34(7):1208-15.

ObjectiveThe goals of this study were to elucidate reasons why patients did or did not receive intracranial pressure (ICP) monitoring and to describe factors influencing hospital mortality after severe traumatic brain injury (TBI).DesignProspective multicenter cohort study.Patients And Participants88,274 patients consecutively admitted to 32 medical, surgical and mixed Austrian ICUs between 1998 and 2004.InterventionsNone.Measurements And Results1,856 patients (2.1% of all ICU admissions) exhibited severe TBI (GCS < 9); of these, 1,031 (56%) had ICP monitoring. The "worst" and the "best" cases were both less likely to receive ICP monitoring. Younger patients, female patients, and patients with isolated TBI were more likely to receive ICP monitoring. Compared with large centers ICP was monitored more frequently [odds ratio (OR) 3.09, CI 2.42-3.94] in medium-sized centers. The 20% of patients with the highest likelihood to receive ICP monitoring were monitored in 91% of cases, and had the lowest hospital mortality (31%, OR 0.78, CI 0.37-1.64). Multivariate analysis revealed that severity of illness, TBI severity, isolated TBI, and the number of cases treated per year were associated with hospital outcome. Compared with the large centers, ORs for hospital mortality were 1.85 (CI 1.42-2.40) for patients from medium-sized centers and 1.91 (CI 1.24-2.93) for patients from small centers.ConclusionsICP monitoring may possibly have some beneficial effects, but this needs further evaluation. Patients with severe TBI should be admitted to experienced centers with high patient volumes since this might improve hospital mortality rates.

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