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Background <p>External lumbar drainage (ELD) of cerebrospinal fluid may help control intracranial pressure following a traumatic brain injury. We aimed to assess the efficacy and safety of ELD in post-traumatic intracranial hypertension (IH).</p> Methods <p>This retrospective monocentric cohort study was conducted in the trauma critical care unit of the regional Level-I trauma centre between January 2012 and December 2022. All traumatic brain injury patients with IH (≥ 22&#xa0;mmHg despite optimal sedation) were included. Data collection focused on the duration and management of IH, complications related to ELD, and outcomes (6-month Glasgow Outcome Scale [GOS]). The influence of ELD on the duration of IH was assessed using a multivariable Cox regression analysis, while its impact on the 6-month GOS (“unfavourable outcome” GOS 1–3, “good outcome” GOS 4–5) was evaluated using a multivariable logistic regression analysis.</p> Results <p>Ninety patients (mean age 37 [SD, 16], injury severity score [ISS] 29 [IQR, 24–34]) were analyzed during the study period. Of these, 50 (56%) benefited from an ELD during their hospitalization (<i>ELD</i> group). The IH duration was significantly reduced in the <i>ELD</i> group (hazard ratio [HR] 1.74 [95%&#xa0;confidence interval (CI) 1.05–2.87; <i>p</i> = 0.03]). One patient (2%) experienced a cerebral herniation following ELD placement, and two others (4%) developed device-associated meningitis. The <i>ELD</i> group was significantly associated with a lower likelihood of an unfavourable outcome (OR 0.32 [95%&#xa0;CI 0.13–0.77]; <i>p</i> = 0.011) compared to the <i>no ELD</i> group.</p> Conclusion <p>ELD appears in our cohort to be a safe and effective strategy to control post-traumatic IH, with an acceptable benefit-risk ratio. Our analysis even suggests a potential outcome improvement in patients treated by ELD compared with those having no cerebrospinal fluid drainage.</p>

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Impact of lumbar cerebrospinal fluid drainage to control intracranial hypertension in patients with severe traumatic brain injury: a retrospective monocentric cohort

  • 期刊论文

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  • 发表日期：

    2025年1月2日

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  • Geoffrey Dagod,
  • Marlène Laurens,
  • Jean-Paul Roustan,
  • Pauline Deras,
  • Elie Courvalin,
  • Mehdi Girard,
  • Hugues Weber,
  • Xavier Capdevila,
  • Jonathan Charbit

摘要

Background

External lumbar drainage (ELD) of cerebrospinal fluid may help control intracranial pressure following a traumatic brain injury. We aimed to assess the efficacy and safety of ELD in post-traumatic intracranial hypertension (IH).

Methods

This retrospective monocentric cohort study was conducted in the trauma critical care unit of the regional Level-I trauma centre between January 2012 and December 2022. All traumatic brain injury patients with IH (≥ 22 mmHg despite optimal sedation) were included. Data collection focused on the duration and management of IH, complications related to ELD, and outcomes (6-month Glasgow Outcome Scale [GOS]). The influence of ELD on the duration of IH was assessed using a multivariable Cox regression analysis, while its impact on the 6-month GOS (“unfavourable outcome” GOS 1–3, “good outcome” GOS 4–5) was evaluated using a multivariable logistic regression analysis.

Results

Ninety patients (mean age 37 [SD, 16], injury severity score [ISS] 29 [IQR, 24–34]) were analyzed during the study period. Of these, 50 (56%) benefited from an ELD during their hospitalization (ELD group). The IH duration was significantly reduced in the ELD group (hazard ratio [HR] 1.74 [95% confidence interval (CI) 1.05–2.87; p = 0.03]). One patient (2%) experienced a cerebral herniation following ELD placement, and two others (4%) developed device-associated meningitis. The ELD group was significantly associated with a lower likelihood of an unfavourable outcome (OR 0.32 [95% CI 0.13–0.77]; p = 0.011) compared to the no ELD group.

Conclusion

ELD appears in our cohort to be a safe and effective strategy to control post-traumatic IH, with an acceptable benefit-risk ratio. Our analysis even suggests a potential outcome improvement in patients treated by ELD compared with those having no cerebrospinal fluid drainage.