Intracranial pressure monitoring in two district general hospital ICUs

There is a growing consensus that, in selected patients, intracranial pressure (ICP) monitoring is an appropriate intervention in district general hospitals. It improves outcome in patients with traumatic brain injury [1] and is safe [2]. In the Southwest region two district general hospitals without on-site neurosurgical facilities have been inserting Camino- fibreoptic transducers in their ICUs since 1997.

I conducted a retrospective case note audit of ICP monitored patients at the two centres. Fifty-one patients had monitors inserted between 6 October 1997 and 28 February 2001. Data were collected on: sex, age, initial Glasgow coma score (GCS), diagnosis, duration of ICP monitoring and incidence and nature of complications. Sixty-nine percent of patients were male, with a median age of 29 (range 1-71 years). Median GCS was 6 and 76% had an initial GCS of 8 or less. The most common indication for ICP monitoring was traumatic brain injury (72%). Other diagnoses were anoxic coma (12%), meningitis (8%), subarachnoid haemorrhage (4%), intracerebral bleed (2%) and encephalitis (2%). Median duration of monitoring was 3 days. Only two patients were monitored for more than 5 days; both these patients received two monitors.

The complication rate was low. One (2%) patient had a minor scalp haemorrhage. One (2%) patient had a small intracerebral haemorrhage, detected as an incidental finding on CT scan; it had no clinical sequelae. One (2%) monitor developed a fault and had to be resited. No infectious complications were seen. The data from this audit adds to the weight of evidence that ICP monitoring in selected patient groups is safe in district general hospitals.