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No benefit to intracranial pressure monitoring in children with TBI
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The use of intracranial pressure monitoring to improve functional survival outcomes in children with severe traumatic brain injury does not increase chances of functional survival, according to a study published in JAMA Pediatrics.
“The overall association of intracranial pressure monitoring with patient outcome is unclear. Therapies to reduce intracranial pressure are mainstays of treatment for severe TBI, and the treatment of elevated intracranial pressure is associated with the best reported outcomes,” Tellen D. Bennett, MD, MS, from pediatric critical care at the University of Colorado School of Medicine, and colleagues wrote. “However, because of the relatively low quality of evidence, the current guidelines for the medical care of children with severe TBI state only that monitoring ‘may be considered.’”
To assess if the monitoring of intracranial pressure (ICP) had an association with enhanced functional survival in children who had sustained a TBI, the researchers conducted a propensity-weighted effectiveness analysis in which data were collected from 30 United States children’s hospitals through two linked national databases. All data were collected between Jan. 1, 2007, and Dec. 31, 2012, and included 3,084 children.
Of the children included, 1,128 were girls and 1,956 were boys (mean age, 7.03 [5.44] years). ICP monitoring was used for 1,002 children (32.4%). Use varied by hospital (6%-50%), and 484 (15.7%) children experienced hospital mortality, discharge to hospice or survival with placement of new tracheostomy and gastrostomy tubes. The researchers did not observe a significant difference in the outcomes of children who received ICP monitoring and those who did not (OR of poor outcome in those who underwent ICP monitoring: 1.31; 95% CI, 0.99-1.74).
Additionally, no difference was observed in mortality in a prespecified secondary analysis between those who received ICP monitoring and those who did not (OR, 1.16; 95% CI, 0.89-1.50), and no difference was found in outcomes between those aged older and younger than 2 years or for those who had unintentional or inflicted injuries.
“This result is consistent with the results of a randomized trial of ICP monitoring of adults, which found no difference in 6-month outcomes between care directed by ICP monitoring vs. imaging and clinical examination,” Bennett and colleagues wrote. “Although this trial has been criticized for its overall high mortality and the limited prehospital and postacute care available to the trial participants, it currently provides the best available evidence.” – by Katherine Bortz
Disclosure: The researchers report no relevant financial disclosures.
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