背景:颅内压(ICP)监测已广泛应用,但是适应症还没有完全发展,和指南遵循得不好。
目的:研究已建立的专家小组(西雅图国际脑损伤共识会议的临床工作组)的监测实践,以检查监测指南与其临床决策之间的匹配,并为考虑插入监护仪的临床医生提供指导。
方法:我们对42位西雅图国际脑损伤共识会议小组成员进行了调查,使用呈现标志的矩阵(格拉斯哥昏迷量表[GCS]总运动或GCS运动,瞳孔检查,和计算机断层扫描诊断)。监视器插入决定是肯定的,不,或不确定(交通信号灯接近)。我们使用单变量回归分析了他们对决策中呈现标志的权重的响应。
结果:根据41名小组成员的选择构建的热图显示,ICP监测仪的使用比指南预测的要广泛。临床检查(GCS)是迄今为止最重要的特征,并且与非线性指南不同。改良的马歇尔计算机断层扫描分类排名第二,学生排名第三。我们构建了一个热图,并列出了代表80%ICP监测仪插入共识的主要临床决定因素。
结论:ICP监测的候选资格超过了已公布的监测插入指标,提示临床认为ICP数据的价值大于简单地检测和监测严重颅内高压。监护仪插入热图作为ICP监护仪插入的潜在指导提供,并刺激研究在不受约束的情况下实际驱动监护仪插入的因素,现实世界的条件。
Intracranial pressure (ICP) monitoring is widely practiced, but the indications are incompletely developed, and
guidelines are poorly followed.
To study the monitoring practices of an established expert panel (the clinical working group from the Seattle International Brain Injury
Consensus Conference effort) to examine the match between monitoring
guidelines and their clinical decision-making and offer guidance for clinicians considering monitor insertion.
We polled the 42 Seattle International Brain Injury
Consensus Conference panel members\' ICP monitoring decisions for virtual patients, using matrices of presenting signs (Glasgow Coma Scale [GCS] total or GCS motor, pupillary examination, and computed tomography diagnosis). Monitor insertion decisions were yes, no, or unsure (traffic light approach). We analyzed their responses for weighting of the presenting signs in decision-making using univariate regression.
Heatmaps constructed from the choices of 41 panel members revealed wider ICP monitor use than predicted by guidelines. Clinical examination (GCS) was by far the most important characteristic and differed from guidelines in being nonlinear. The modified Marshall computed tomography classification was second and pupils third. We constructed a heatmap and listed the main clinical determinants representing 80% ICP monitor insertion
consensus for our recommendations.
Candidacy for ICP monitoring exceeds published indicators for monitor insertion, suggesting the clinical perception that the value of ICP data is greater than simply detecting and monitoring severe intracranial hypertension. Monitor insertion heatmaps are offered as potential guidance for ICP monitor insertion and to stimulate research into what actually drives monitor insertion in unconstrained, real-world conditions.