A Consensus-Based Interpretation of the Benchmark Evidence from South American Trials: Treatment of Intracranial Pressure Trial
Year: 2015
Type: article
Abstract: Widely-varying published and presented analyses of the Benchmark Evidence From South American Trials: Treatment of Intracranial Pressure (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 group's general opinions, followed by an in-person meeting wherein individual statements were refined. Statements required an agreement threshold of more than 70% by blinded voting for approval. Seven precisely-worded statements resulted, with agreement levels of 83% to 100%. These statements, which should be read in toto to properly reflect the group's consensus positions, conclude that the BEST TRIP trial: 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.
Source: Journal of Neurotrauma
Authors: Randall M. Chesnut, Thomas P. Bleck, Giuseppe Citerio, Jan Classen, D. James Cooper, William M. Coplin, Michael N. Diringer, Per-Olof Grände, J. Claude Hemphill, Peter J. Hutchinson, Peter Le Roux, Stephan A. Mayer, David K. Menon, John A. Myburgh, David O. Okonkwo, Claudia S. Robertson, Juan Sahuquillo, Nino Stocchetti, Gene Sung, Nancy Temkin, Paul M. Vespa, Walter Videtta, Howard Yonas
Institutions: University of Washington, Rush University Medical Center, University of Milano-Bicocca, Columbia University Irving Medical Center, Columbia University, The Alfred Hospital, St. Anthony Hospital, Washington University in St. Louis, Skåne University Hospital, University of California, San Francisco, University of California System, University of Cambridge, Addenbrooke's Hospital, Lankenau Medical Center, Icahn School of Medicine at Mount Sinai, The George Institute for Global Health, UNSW Sydney, The George Institute for Global Health, University of Pittsburgh, Baylor College of Medicine, Vall d'Hebron Hospital Universitari, University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Southern California, University of California, Los Angeles, Hospital Posadas, University of New Mexico
Language: English
Subfield: Neurology
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W2133892859