title: National variability in intracranial pressure monitoring and craniotomy for children with moderate to severe traumatic brain injury.
abstract: BACKGROUND
  Traumatic brain injury (TBI) is a significant cause of mortality and disability in children. Intracranial pressure monitoring (ICPM) and craniotomy/craniectomy (CRANI) may affect outcomes. Sources of variability in the use of these interventions remain incompletely understood.
  
  
  OBJECTIVE
  To analyze sources of variability in the use of ICPM and CRANI.
  
  
  METHODS
  Retrospective cross-sectional study of patients with moderate/severe pediatric TBI with the use of data submitted to the American College of Surgeons National Trauma Databank.
  
  
  RESULTS
  We analyzed data from 7140 children at 156 US hospitals during 7 continuous years. Of the children, 27.4% had ICPM, whereas 11.7% had a CRANI. Infants had lower rates of ICPM and CRANI than older children. A lower rate of ICPM was observed among children hospitalized at combined pediatric/adult trauma centers than among children treated at adult-only trauma centers (relative risk = 0.80; 95% confidence interval 0.66-0.97). For ICPM and CRANI, 18.5% and 11.6%, respectively, of residual model variance was explained by between-hospital variation in care delivery, but almost no correlation was observed between within-hospital tendency toward performing these procedures.
  
  
  CONCLUSIONS
  Infants received less ICPM than older children, and children hospitalized at pediatric trauma centers received less ICPM than children at adult-only trauma centers. In addition, significant between-hospital variability existed in the delivery of ICPM and CRANI to children with moderate-severe TBI.
authors.forename: William
authors.initials: W
authors.lastname: Van Cleve
authors.affiliation: *Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, Washington; ‡Department of Epidemiology, University of Washington, Seattle, Washington; §Departments of Neurological Surgery and Global Health Medicine, University of Washington, Seattle, Washington; ¶Harborview Injury Prevention and Research Center, Seattle, Washington; ‖Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington; #Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania; **Department of Pediatrics, Northwestern University, Chicago, Illinois; ‡‡Department of Surgery, Ohio State University College of Medicine, Columbus, Ohio; §§Harbor-UCLA Medical Center, Los Angeles BioMedical Research Institute and David Geffen School of Medicine at UCLA, Los Angeles, California; ¶¶Divisions of Neurosurgery and Pediatric Neurology, UCLA, Los Angeles, California; ‖‖College of Engineering, University of Washington, Seattle, Washington; ##School of Nursing, University of Washington, Seattle, Washington.
authors.forename: William Van
authors.initials: WV
authors.lastname: Cleve
authors.forename: Mary A
authors.initials: MA
authors.lastname: Kernic
authors.forename: Richard G
authors.initials: RG
authors.lastname: Ellenbogen
authors.forename: Jin
authors.initials: J
authors.lastname: Wang
authors.forename: Douglas F
authors.initials: DF
authors.lastname: Zatzick
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Bell
authors.forename: Mark S
authors.initials: MS
authors.lastname: Wainwright
authors.forename: Jonathan I
authors.initials: JI
authors.lastname: Groner
authors.forename: Richard B
authors.initials: RB
authors.lastname: Mink
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Giza
authors.forename: Linda Ng
authors.initials: LN
authors.lastname: Boyle
authors.forename: Pamela H
authors.initials: PH
authors.lastname: Mitchell
authors.forename: Frederick P
authors.initials: FP
authors.lastname: Rivara
authors.forename: Monica S
authors.initials: MS
authors.lastname: Vavilala
mesh_terms: D000293:Adolescent; D001930:Brain Injuries / Q000601:surgery*; D003399:Craniotomy / Q000379:methods* / Q000592:standards; D003430:Cross-Sectional Studies; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D007427:Intracranial Pressure / Q000502:physiology*; D064795:Intraoperative Neurophysiological Monitoring; D008297:Male; D012189:Retrospective Studies; D012720:Severity of Illness Index