Correlation of ICP and Outcome in Severe Head Injuries

Abstract

During 1980-1981, 66 patients with severe head injury were admitted and underwent intracranial pressure (ICP) monitoring by the subarachnoid catheter method. Ninety percent of the patients were admitted within 6 hours after injury and 70 percent were started on ICP monitoring within 12 hours of injury. All patients were of Glasgow Coma Scale 8 or less. Their average age was 37.2 years. The periods of continuous ICP monitoring were 1-17 days (average 6.0 ± 3.5 SD). After admission, vital signs and neurological states were checked, endotracheal tube was intubated with or without barbiturate anesthesia, and CT scanning was carried out. Fifty percent of patients needed intracranial operations. All of the patients were uniformly treated; all received high dose corticosteroids, osmotic agents, and mild mechanical hyperventilation and, if ICP was 25 mmHg or greater, barbiturates were administered. ICP was related to outcome one year after of injury. Cases with initial ICP within the ranges of 0 to 9 mmHg, 10 to 19, 20 to 29, 30 to 39, and over 40 mmHg showed mortalities of 26.7, 40, 53.8, 60.0, and 100%, respectively (χ2 = 17.57, P < 0.01).Maximal ICP within the ranges of 0 to 19 mmHg, 20 to 29,30 to 39,40 to 59, and over 60 mmHg was related to the mortalities of 11.1, 20.0, 25.0, 60.0, and 87.5%, respectively (χ2 = 24.99, P < 0.01). Thus, there were significant correlations between initial and maximal ICP levels and outcome. © 1983, The Japan Neurosurgical Society. All rights Reserved.