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A Consensus-based Interpretation of the BEST TRIP ICP Trial.

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Author

  • Randall Chesnut
  • Thomas Bleck
  • Giuseppe Citerio
  • Jan Claassen
  • D James Cooper
  • William Coplin
  • Michael Diringer
  • Per-Olof Grände
  • Claude M Hemphill
  • Peter John Hutchinson
  • Peter LeRoux
  • Stephan Mayer
  • David Menon
  • John Myburgh
  • David O Okonkwo
  • Claudia S Robertson
  • Juan Sahuquillo
  • Nino Stocchetti
  • Gene Sung
  • Nancy Temkin
  • Paul M Vespa
  • Walter Videtta
  • Howard Yonas
Show all

Summary, in English

Widely varying published and presented analyses of the BEST TRIP randomized controlled trial of intracranial pressure (ICP) monitoring have suggested denying trial generalizability, questioning the need for ICP monitoring in severe traumatic brain injury (sTBI), re-assessing current clinical approaches to monitored ICP, and initiating a general ICP-monitoring moratorium. In response to this dissonance, 23 clinically-active, international opinion leaders in acute-care sTBI management met to draft a consensus statement to interpret this study. A Delphi-method-based approach employed iterative pre-meeting polling to codify the groups general opinions, followed by an in-person meeting wherein individual statements were refined. Statements required an agreement threshold of > 70% by blinded voting for approval. Seven precisely-worded statements resulted, with agreement levels of 83-100%. These statements, which should be read in toto to properly reflect the group's consensus positions, conclude that this study: 1) studied protocols, not ICP-monitoring per se; 2) applies only to those protocols and specific study groups and should not be generalized to other treatment approaches or patient groups; 3) strongly calls for further research on ICP interpretation and use; 4) should be applied cautiously to regions with much different treatment milieu; 5) did not investigate the utility of treating monitored ICP in the specific patient group with established intracranial hypertension; 6) should not change the practice of those currently monitoring ICP; and 7) provided a protocol, used in non-monitored study patients, that should be considered when treating without ICP monitoring. Consideration of these statements can clarify study interpretation and avoid "collateral damage".

Publishing year

2015

Language

English

Pages

1722-1724

Publication/Series

Journal of Neurotrauma

Volume

32

Issue

22

Document type

Journal article

Publisher

Mary Ann Liebert, Inc.

Topic

  • Anesthesiology and Intensive Care

Status

Published

ISBN/ISSN/Other

  • ISSN: 1557-9042