Intracranial pressure monitoring in severe isolated pediatric blunt head trauma.
Very little research regarding standard treatments for pediatric traumatic brain injury (PTBI) exists. The objective of this study was to examine the use of intracranial pressure (ICP) monitoring devices in PTBI and to determine if its use was associated with any outcome benefit. Data were collected from the Trauma Registry over an 11-year period (1996-2006) on all blunt trauma pediatric patients (age < 14 years) with an initial Glasgow Coma Scale score < or =8. Data collected included: demographics, admission Glasgow Coma Scale score, mechanism of injury, Injury Severity Score, Abbreviated Injury Score, and use of an ICP monitor. Outcome measures included: mortality, complications, discharge location, and capacity. Thirty-three (25%) of 129 blunt PTBI patients had ICP monitors placed. Patients with monitors were more severely injured overall (Injury Severity Score: 25 vs. 18, P = 0.001) and had more severe head injury (81% head Abbreviated Injury Score > 3 vs. 55%, P = 0.01) than patients without monitors. However, there was no difference in mortality (28% vs. 35%, P = 0.52), discharge location (P = 0.10), and discharge capacity (P = 0.84). After multivariable analysis to adjust for the differences between the two study groups, the use of ICP monitor provided no survival benefit (adjusted odds ratio: 1.1; 95% confidence interval [CI]: 0.3-4.1; adjusted P value = 0.85). The use of ICP monitor was, however, independently associated with a higher risk of developing extracranial complications (adjusted odds ratio: 4.3; 95% CI: 1.2-16.4; adjusted P value = 0.025). In conclusion, the use of ICP monitors in pediatric patients with severe isolated head injury provided no survival benefit and was associated with an increased risk of complications.
Salim
Ali
A
Department of Surgery, Division of Trauma and Critical Care, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA. ali.salim@cshs.org
Hannon
Matthew
M
Brown
Carlos
C
Hadjizacharia
Pantelis
P
Backhus
Leah
L
Teixeira
Pedro G R
PG
Chan
Linda S
LS
Ford
Henri
H
D000293:Adolescent; D000367:Age Factors; D001930:Brain Injuries / Q000401:mortality / Q000503:physiopathology* / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D007427:Intracranial Pressure / Q000502:physiology*; D008297:Male; D008991:Monitoring, Physiologic; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome