Mechanism-Driven Differences in Initial ICP Response and Sustained Intracranial Hypertension in Traumatic Brain Injury

Introduction: Mechanisms of traumatic brain injury (TBI), such as ground-level falls and penetrating head injuries, create distinct injury patterns that may necessitate tailored ICP monitoring strategies. This study evaluates initial ICP trends and sustained elevations across trauma mechanisms, supporting trauma-specific protocols for managing intracranial hypertension.

Methods: A retrospective analysis was conducted on 466 patients with severe TBI and ICP monitor placement at IU Health Methodist Hospital from 2015 to 2024. Trauma mechanisms were categorized, and initial ICP rates of change over the first 6 hours post-insertion were analyzed. ICP elevations above 20 mmHg and sustained elevated ICP episodes (longer than 2 hours) were examined across trauma types. Statistical significance was assessed using ANOVA and linear regression (p < 0.05).

Results: Trauma type significantly impacted ICP trends (p < 0.001). Penetrating trauma had the most pronounced initial ICP decline (slope = -1.97, p = 0.0003) over the first 6 hours, while MVAs showed a slight increase (slope = 0.126, p = 0.308). Penetrating trauma also exhibited the highest proportion of ICP values above 20 mmHg (34.6%) and the greatest likelihood of sustained elevated ICP (13.4%). Falls from height had 28.8% of measurements above 20 mmHg and a 9.9% sustained rate, while blunt trauma had 27.7% of measurements above 20 mmHg, with sustained elevations in 9.4% of cases. Ground-level falls and found-down cases were least likely to exceed or sustain ICP above 20 mmHg (15.1% and 13.9%, respectively).

Conclusion : Trauma-specific differences in initial ICP trends and sustained elevations suggest that individualized monitoring strategies based on trauma mechanism could optimize resource use and outcomes in TBI care.