title: Questioning the need for ICU level of care in pediatric patients following elective uncomplicated craniotomy for brain tumors.
abstract: OBJECTIVE The object of this study is to address what factors may necessitate the need for intensive care monitoring after elective uncomplicated craniotomy in pediatric patients who are initially managed in a non-intensive care unit setting postoperatively. METHODS A retrospective chart review was undertaken for all patients who underwent elective craniotomy for brain tumor between April of 2007 and April of 2012 and who were directly admitted to the floor postoperatively. Factors such as age, tumor type, craniotomy location, neurological comorbidities, reason for transfer to intensive care unit (ICU) level of care (if applicable), time between admittance to floor and transfer to ICU level of care, and reason for transfer to ICU level of care were assessed. RESULTS Adjusted logistic regression found 2 significant positive predictors of postoperative transfer to the ICU after initial admission to the floor: primitive neuroectodermal tumor pathology (OR 44.10, 95% CI 1.24-1572.16, p = 0.04), and repeat craniotomy during the same hospitalization (OR 13.97, 95% CI 1.21-160.66, p = 0.03). Conversely, 1 negative factor was found: low-grade glioma pathology (OR 0.05, 95% CI 0.00-0.87, p = 0.04). CONCLUSIONS Select pediatric patients may not require ICU level of care after elective uncomplicated pediatric craniotomy. Additional studies are needed to adequately address which patients would benefit from initial ICU admittance following elective craniotomies for brain tumors.
authors.affiliation: Department of Neurosurgery, University of California, San Diego;
authors.forename: Brandon C
authors.initials: BC
authors.lastname: Gabel
authors.affiliation: Department of Neurosurgery, University of California, San Diego;
authors.forename: Joel
authors.initials: J
authors.lastname: Martin
authors.affiliation: Department of Neurosciences and Pediatrics, University of California, San Diego, and Rady Children's Hospital; and.
authors.forename: John R
authors.initials: JR
authors.lastname: Crawford
authors.affiliation: Department of Neurosurgery, University of California, San Diego;|Department of Neurosciences and Pediatrics, University of California, San Diego, and Rady Children's Hospital; and.|Department of Neurosurgery, Rady Children's Hospital, San Diego, California.
authors.forename: Michael
authors.initials: M
authors.lastname: Levy
mesh_terms: D000293:Adolescent; D000367:Age Factors; D001932:Brain Neoplasms / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D003363:Cost Control; D003399:Craniotomy; D003422:Critical Care / Q000191:economics / Q000592:standards*; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D007223:Infant; D007362:Intensive Care Units / Q000191:economics / Q000592:standards / Q000706:statistics & numerical data*; D008297:Male; D010343:Patient Admission / Q000592:standards / Q000706:statistics & numerical data*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors
keywords: ADD = attention-deficit disorder; ADHD = attention-deficit hyperactivity disorder; DNET = dysembyroplastic neuroepithelial tumors; ICD-9 = International Classification of Diseases, Ninth Revision; ICU = intensive care unit; NF1 = neurofibromatosis Type 1; NF2 = neurofibromatosis Type 2; PNET = primitive neuroectodermal tumor; brain tumor; craniotomy; intensive care unit; oncology