Abstract| Volume 47, ISSUE 4, P505-506, October 2014

Intracranial Pressure Monitoring In Children With Severe Traumatic Brain Injury National Trauma Data Bank–Based Review Of Outcomes

Alkhoury F, Kyriakides TC. JAMA Surg 2014;149:544–8.
      The objective of this retrospective observational study was to determine if there is a survival benefit to intracranial pressure (ICP) monitoring in pediatric trauma patients. Data were acquired from the National Trauma Data Bank (version 6.2, 2001–2006). A total of 3107 patients were identified (ICP monitoring group, n = 283; and control, n = 2817) using inclusion criteria of younger than 17 years admitted to intensive care unit (ICU) with blunt traumatic brain injury (TBI), Injury Severity Score (ISS) > 9, and Glascow Coma Scale (GCS) score < 9. Patients were excluded if ICU stay was <24 h or had incomplete records. Only 7.7% of patients who met monitoring criteria recommended by the Brain Trauma Foundation (BTF) received ICP monitoring. Stepwise logistic regression methods were used to assess if ICP monitoring with or without other variables (age, sex, ISS, Revised Trauma score, and GCS score) was associated with survival. The adjustment odds ratio (OR) for admission GCS, age group, sex, Revised Trauma Score, and ISS only showed potential reduction in mortality with ICP monitoring and GCS score of 3 (OR = 0.64; 95% CI 0.43–1.00). Furthermore, with ICP monitoring came longer hospital stay (21.0 days vs. 10.4 days; p < 0.001), longer ICU stay (12.6 vs. 6.3 days; p < 0.001), and more ventilator days (9.2 vs. 4.7; P 0.001).
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