Care based on intracranial pressure monitoring may not be superior to care based on imaging and clinical examination for patients with traumatic brain injury (TBI), according to research published in the December 27, 2012, New England Journal of Medicine. There was no significant difference in survival time, impaired consciousness, functional status, or neuropsychologic status among patients with TBI randomized to one of the two types of care.
Randall M. Chesnut, MD, Professor of Neurologic Surgery at the University of Washington in Seattle, and colleagues conducted a multicenter, controlled trial in which 324 patients with severe TBI were randomly assigned to guidelines-based management (ie, intracranial pressure monitoring) or imaging and clinical examination. Trained examiners who were unaware of treatment assignments assessed patients’ outcomes at three and six months after study onset. Tests included measures of mental status, working memory, information processing speed, episodic memory and learning, verbal fluency, executive function, and motor dexterity.