Severe traumatic brain injury remains a leading cause of morbidity and mortality. Despite recommendations from the Brain Trauma Foundation, there is wide variability in treatment paradigms for severe TBI. We aim to elucidate the variability of treatment, particularly neurosurgical procedures and how it affects mortality.
Adult Patients (<65 years) with a severe isolated TBI who were treated at an ACS Level 1 trauma center were identified in the National Trauma Database for the years 2007 through 2016. ICD-9 procedure codes were used to identify primary treatment approaches: intracranial pressure monitoring and cranial surgery (craniotomy/craniectomy).
Among the 25,327 patients with severe isolated traumatic brain injury, 14.0% and 18.0% of total patients underwent intracranial pressure monitoring or cranial surgery, respectively. Intracranial pressure monitoring reduced the odds of mortality, OR 0.89 (0.81, 0.98), but not to the extent of cranial surgery, OR 0.71 (0.65, 0.77).
BTF guidelines recommend placement of intracranial pressure monitor for severe TBI, however only 14 % of patients with isolated, severe TBI underwent intracranial pressure monitoring from 2007 to 2016. Intracranial pressure monitoring and cranial surgery decreases the odds of inpatient mortality in patients with severe TBI.

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