BEST-TRIP: Difference between revisions
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=== Reference === | === Reference === | ||
Chesnut RM, Temkin N, Carney N, et al. A Trial of Intracranial-Pressure Monitoring in [[Traumatic Brain Injury]]. ''N Engl J Med'' 2012; 367:2471-2481. | Chesnut RM, Temkin N, Carney N, et al. A Trial of Intracranial-Pressure Monitoring in [[Traumatic Brain Injury]]. ''N Engl J Med'' 2012; 367:2471-2481. | ||
{{#fas:file-pdf}} [[File:BEST-TRIP.pdf]] | |||
[[Category:Neurotrauma]] | |||
[[Category:Traumatic Brain Injury]] | |||
Revision as of 04:52, 20 July 2024
BEST-TRIP Trial Summary
Objective
The BEST-TRIP (Benchmark Evidence from South American Trials: Treatment of Intracranial Pressure) trial aimed to determine whether intracranial pressure (ICP) monitoring improves outcomes in patients with severe traumatic brain injury.
Methods
- Design: Multicenter, randomized controlled trial.
- Participants: 324 patients aged 13 years or older with severe traumatic brain injury and treated in ICUs in Bolivia or Ecuador.
- Interventions: Patients were randomized to either ICP monitoring with a protocol to maintain pressure below 20 mm Hg (pressure-monitoring group) or a protocol based on imaging and clinical examination (imaging–clinical examination group).
- Outcome Measures: The primary outcome was a composite measure including survival time, level of consciousness, functional status at 3 and 6 months, and neuropsychological status at 6 months.
Results
- Primary Outcome: No significant difference in composite scores between the pressure-monitoring group and the imaging–clinical examination group (score, 56 vs. 53; P = 0.49).
- Mortality Rates: Six-month mortality was 39% in the pressure-monitoring group and 41% in the imaging–clinical examination group (P = 0.60).
- ICU Stay: The median length of stay in the ICU was similar between the groups (12 days for pressure-monitoring vs. 9 days for imaging–clinical examination; P = 0.25).
- Brain-Specific Treatments: Patients in the imaging–clinical examination group received more brain-specific treatments compared to the pressure-monitoring group (4.8 vs. 3.4 days; P = 0.002).
Conclusion
For patients with severe traumatic brain injury, care focused on maintaining monitored intracranial pressure at 20 mm Hg or less did not show superiority over care based on imaging and clinical examination. These findings suggest that routine intracranial pressure monitoring may not provide additional benefits in improving patient outcomes in this context.
Reference
Chesnut RM, Temkin N, Carney N, et al. A Trial of Intracranial-Pressure Monitoring in Traumatic Brain Injury. N Engl J Med 2012; 367:2471-2481. File:BEST-TRIP.pdf