436 Use of Ventriculostomy for Severe Traumatic Brain Injury Is Associated With Reduced Mortality Compared to Intraparenchymal Monitor Use: A Propensity Score-Matched Analysis

INTRODUCTION: There is a lack of data on whether intracranial pressure (ICP)-guided therapy with an intraparenchymal fiberoptic monitor (IPM) or an external ventricular drain (EVD) leads to superior mortality outcomes. METHODS: Retrospective analysis of patients with severe TBI that required IPM or EVD placement for ICP-guided therapy from 1/1/2010-12/31/2020. The data was obtained from the Pennsylvania Trauma Systems Foundation (PTSF) registry. RESULTS: A total of 2,305 patients met the inclusion criteria with 1,048 (45.5%) IPM and 1,257 (54.5%) EVD placed. A craniectomy was performed in 47.0% of the patients in the IPM cohort and 66.0% of the EVD cohort (p < 0.001). Multivariable logistic regression analysis showed that older age (OR 1.03, p < 0.001), decreasing GCS score (OR 1.16, p < 0.001), requiring craniectomy (OR 1.22, p = 0.049), and an IPM (OR 1.40, p = 0.001) were significant predictors of mortality. A propensity score-matched analysis was performed, adjusting the cohorts for age, gender, race, GCS, ISS, and craniotomy. EVD use is associated with a significant 28% decrease in inpatient mortality when compared to IPM (OR 0.72, p < 0.001). Hospital length of stay was also significantly shorter in the EVD cohort (OR 0.86, p = 0.03). CONCLUSIONS: A significant decrease in mortality was associated with the use of EVD in comparison to IPM based on our propensity score-matched analysis. Further investigation.