Impacts of intracranial pressure monitoring on mortality and length of stay in severe traumatic brain injury: a systematic review and meta-analysis
In brief
ICP monitoring lowers death rate by roughly five percent in severe brain injury
A meta-analysis of 31 studies involving 122 000 patients with severe traumatic brain injury found that intracranial pressure monitoring was linked to a median mortality of 28.6% versus 33.2% without monitoring, an absolute reduction of about five percent. Functional neurological outcomes were not consistently improved, and monitored patients tended to stay longer in the ICU and hospital, with variable complication reporting. Further controlled research is needed to confirm causality.
- Journal
- European journal of trauma and emergency surgery : official publication of the European Trauma Society (Q1)
- Published
- 12 August 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Michael Merakis, NakHyun Kim, Gina Velli, Zsolt J Balogh
- PMID
- 42584695
- DOI
- 10.1007/s00068-026-03302-5
Why clinicians should know about it
- Picked for Critical Care and Intensive Care Medicine (top studies of the week, 16 August 2026): High-quality evidence in a top journal
- Picked for Epidemiology (top studies of the week, 16 August 2026).
Abstract
PURPOSE: This systematic review and meta-analysis examined the association between intracranial pressure monitoring (ICPm) and mortality in patients with severe traumatic brain injury (sTBI), with additional focus on functional neurological outcomes and intensive care unit (ICU) and hospital length of stay (LOS). METHODS: This review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was registered with PROSPERO (CRD42025643607). MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials were searched through August 1, 2025, for studies comparing ICP-monitored and non-ICP-monitored patients with traumatic brain injury. Eligible study designs included randomized controlled trials, prospective observational cohort studies, retrospective observational cohort studies, registry-based cohort studies, and case-control studies. Study quality was assessed using the Strengthening the Reporting of Observational Studies in Epidemiology checklist, Risk of Bias 2.0 for randomized trials, and the Oxford Centre for Evidence-Based Medicine Levels of Evidence framework. RESULTS: Thirty-one studies met inclusion criteria. The mortality meta-analysis included 121,799 patients. Pooled crude analysis showed lower mortality in ICP-monitored patients than in non-monitored patients (OR 0.79, 95% CI 0.68-0.91, p = 0.002), with high heterogeneity (I²=92%). Across studies with extractable group-level mortality percentages, median mortality was 28.6% in ICP-monitored patients and 33.2% in non-monitored patients. Functional neurological outcomes were inconsistently reported and did not show a consistent benefit with ICPm. ICU and hospital LOS were generally longer in ICP-monitored patients. Ten studies reported complication data, most commonly infection, hemorrhagic events, and mechanical or device-related complications; reporting was heterogeneous and precluded pooled analysis. CONCLUSIONS: ICPm was associated with lower crude mortality in sTBI; however, substantial heterogeneity and residual confounding limit causal interpretation. Functional outcomes did not show consistent benefit. Complication reporting was inconsistent, but reported events included infection, hemorrhage, and device-related complications. Future studies should standardize functional outcome reporting and adjust for key confounders. LEVEL OF EVIDENCE: Systematic review and meta-analysis; Level III.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.