Intracranial Pressure is a Better Predictor of Mortalitythan Cerebral Perfusion Pressure

Objective: To evaluate whether elevated intracranial pressure (ICP) or depressed cerebral perfusion pressure (CPP) is a better predictor of intracranial compartment syndrome and long-term functional outcomes in blunt traumatic brain injury. Methods: This was a retrospective evaluation of data collected on 203 patients with blunt traumatic brain injury who were admitted to Miami Valley Hospital, a Level I trauma center, over a 2 years period, whose initial hospital management required an intracranial pressure monitor. Serial measurements of ICP and CPP were recorded during the patients’ hospital stay. These patients were then evaluated at 3,6,12 and 24 months post-injury to assess their outcome based on functional status, as defined by death vegetative state, severe disability, moderate disability and good recovery. Results: Utilizing an ICP cut-off value of 25 or greater and a CPP value of less than 60 at any point during the patients’ hospital course, ICP elevation consistently correlated with a higher percentage of deaths and persistent vegetative state than a depression in CPP value. Outcomes as measured by severe or moderate disability where similar in both groups. However, neither measure approached statistical significance. Conclusion: ICP appears to be a better predictor of intracranial compartment syndrome and extent of brain injury, predicting better than CPP values, the outcome of death or persistent vegetative state. This may help to predict prognosis, change management strategies and guide discussions with family, especially in the early phase of injur