Timing of Intracranial Pressure Monitoring in Traumatic Brain Injury: A Systematic Review and Meta-Analysis.

Objective: This study reviews the effect of the timing of intracranial pressure (ICP) monitor placement on mortality and length of hospital and intensive care unit stay outcomes.

Methods: This systematic review and meta-analysis adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines, searching 3 databases for English-language studies on traumatic brain injury (TBI) and ICP monitoring up to November 2024. The PECO framework defined eligibility criteria, focusing on patients with TBI, timing of ICP placement, and various outcomes. Two authors independently reviewed studies and extracted data, assessing bias using the Newcastle-Ottawa Scale. Statistical analyses were performed using R statistical software, applying random effects models for outcome comparisons.

Results: 4371 articles were screened; 7 studies with a total of 5884 patients were included. The analysis of mortality outcomes from 5 studies involving 5816 patients showed no significant difference between early (considering a 6-hour or 4-hour cutoff) and late ICP monitoring (relative risk: 0.98; 95% confidence interval: 0.56; 1.71, I = 70%). Subgroup analyses based on age, disease severity, and time cutoff also yielded nonsignificant results. Publication bias assessments indicated no significant bias (P = 0.31). Additionally, no significant differences were found in hospital length of stay or intensive care unit length of stay.

Conclusions: The systematic review and meta-analysis revealed no significant differences in mortality, hospital length of stay, and intensive care unit length of stay between early and late ICP monitoring in TBI patients. The lack of definitive evidence underscores the need for further research to establish optimal timing and improve clinical outcomes in TBI management.