Lack of Standardization in Determination of Intracranial Pressure

Abstract

BackgroundIntracranial pressure (ICP) values guide treatment and diagnosis in the ICU. Lack of agreement on ICP determination reduces the validity of ICP as a predictor variable in research and clinical practice. This study explores international perspectives of interpreting an ICP tracing to document an ICP value across varying lengths of time.MethodsThis was a prospective anonymous online survey study of clinician practice of ICP measurement using patient data showing an ICP trend. Participants were shown one of three scenarios at 1-minute, 3-minute, and 5-minute ICP trends. It wasn't possible to randomized participants, however multiple reading improves precision. Paired t-test was used to explore for differences within each scenario and between each epoch.ResultsThere were a total of 332 international responses which came from 247 nurses, 43 attending physicians, 29 nurse practitioners, and 12 physicians in training. Estimates of ICP were significantly different for two of the three scenarios (p < .0001). The range of ICP values was largest during the 3-minute epoch (from 5 to 40 mmHg).ConclusionsThere is a wide and inconsistent variation in the determination of ICP with significant difference between for two of the three scenarios. Without a standardized amount of time to provide to clinicians, variability in ICP reporting will continue.