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

Chesnut, Randall; Bleck, Thomas; Citerio, Giuseppe; Claassen, Jan; Cooper, D James; Coplin, William; Diringer, Michael; Grände, Per-Olof LU ; Hemphill, Claude M and Hutchinson, Peter John, et al. (2015) In Journal of Neurotrauma 32(22). p.1722-1724
Abstract
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... (More)
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". (Less)
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Journal of Neurotrauma
volume
32
issue
22
pages
1722 - 1724
publisher
Mary Ann Liebert, Inc.
external identifiers
  • pmid:26061135
  • wos:000364401500002
  • scopus:84947079301
ISSN
1557-9042
DOI
10.1089/neu.2015.3976
language
English
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yes
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ad24cc09-fb3c-45a2-b8ae-096b85205f41 (old id 7487082)
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http://www.ncbi.nlm.nih.gov/pubmed/26061135?dopt=Abstract
date added to LUP
2015-07-08 11:28:29
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2017-10-22 03:26:08
@article{ad24cc09-fb3c-45a2-b8ae-096b85205f41,
  abstract     = {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".},
  author       = {Chesnut, Randall and Bleck, Thomas and Citerio, Giuseppe and Claassen, Jan and Cooper, D James and Coplin, William and Diringer, Michael and Grände, Per-Olof and Hemphill, Claude M and Hutchinson, Peter John and LeRoux, Peter and Mayer, Stephan and Menon, David and Myburgh, John and Okonkwo, David O and Robertson, Claudia S and Sahuquillo, Juan and Stocchetti, Nino and Sung, Gene and Temkin, Nancy and Vespa, Paul M and Videtta, Walter and Yonas, Howard},
  issn         = {1557-9042},
  language     = {eng},
  number       = {22},
  pages        = {1722--1724},
  publisher    = {Mary Ann Liebert, Inc.},
  series       = {Journal of Neurotrauma},
  title        = {A Consensus-based Interpretation of the BEST TRIP ICP Trial.},
  url          = {http://dx.doi.org/10.1089/neu.2015.3976},
  volume       = {32},
  year         = {2015},
}