Impact of Invasive Intracranial Pressure Monitoring on Outcomes in Older Adults with Severe Traumatic Brain Injury: A Systematic Review and Meta-Analysis

Cueva-Cañola L.E.; Natera-Rodriguez D.E.; Ramírez-Navarro D.I.; Gasca J.A.; Gómez Villarroel R.A.; Herrera Quinteros M.R.; Beltran-De la Fuente A.C.; La Madrid Barreto A.K.; Grande A.W.; Armonda R.; Chang J.; Rangel-Castilla L. · Neurocritical Care (2026) · DOI: 10.1007/s12028-026-02555-7

Resumen

Background: The benefit of invasive intracranial pressure monitoring (ICPM) in older adults with severe traumatic brain injury (TBI) remains uncertain. Current recommendations are extrapolated from mixed-age populations despite age-related physiological differences. We conducted a systematic review and meta-analysis to evaluate outcomes associated with ICPM in older adults meeting guideline-based criteria. Methods: We searched PubMed, Embase, Web of Science, and Cochrane from inception to 17 November 2025 (CRD420251208512). Studies enrolling older adults (> 55 years) with severe TBI, defined as Glasgow Coma Scale (GCS) ≤ 8, comparing management with versus without ICPM were included. Random-effects meta-analyses using restricted maximum likelihood with Hartung–Knapp adjustment were performed. Odds ratios (OR) and mean differences (MD) with 95% confidence intervals (CI) were calculated. Outcomes included in-hospital mortality and favorable discharge (defined as discharge to home or inpatient rehabilitation), as well as hospital length of stay (LOS), ICU LOS, and duration of mechanical ventilation (MV). Risk of bias was assessed with ROBINS-I and certainty with GRADE. Results: Six observational cohort studies including 12,282 patients were analyzed; 34.5% underwent ICPM. Mean age was 71.6 ± 9.1 years and mean GCS was 4.0 ± 2.2. ICPM was not associated with reduced in-hospital mortality (OR = 0.83, 95% CI 0.44–1.58) or improved favorable discharge (OR = 1.04, 95% CI 0.47–2.26). Hospital LOS did not differ significantly (MD = 7.13 days, 95% CI − 0.56 to 14.82). ICPM was associated with longer ICU LOS (MD = 5.02 days, 95% CI 1.38–8.65). Duration of MV showed no significant difference (MD = 4.74 days; 95% CI − 3.15 to 12.63). Heterogeneity was substantial across outcomes and overall certainty of evidence was very low. Conclusions: In older adults with severe TBI, ICPM was not associated with improved survival or discharge outcomes but was linked to increased ICU utilization. These results may inform clinical decision-making when balancing potential benefits and burdens of invasive monitoring in older patients, given the limited certainty of available evidence. © Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society 2026.

Instituciones: Universidad Nacional de Piura