A Consensus-Based Interpretation of the Benchmark Evidence from South American Trials: Treatment of Intracranial Pressure Trial

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 TemkinPaul M. Vespa, Walter Videtta, Howard Yonas

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

87 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)1722-1724
Number of pages3
JournalJournal of neurotrauma
Issue number22
StatePublished - Nov 15 2015


  • BEST TRIP trial
  • Consensus Development Conference
  • intracranial pressure
  • neurocritical care
  • traumatic brain injury

ASJC Scopus subject areas

  • Clinical Neurology


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