Intracranial Pressure Monitoring in Infants and Young Children with Traumatic Brain Injury

Details

• Alternative Title:
  Pediatr Crit Care Med
• Personal Author:
  Dixon, Rebecca R. ; Nocera, Maryalice ; Zolotor, Adam J. ; Keenan, Heather T.
• Description:
  Objective ; To examine the use of intracranial pressure monitors and treatment for elevated intracranial pressure in children less than or equal to 24 months with traumatic brain injury in North Carolina between April 2009 and March 2012, and compare this to a similar cohort recruited 2000 – 2001. ; Design ; Prospective, observational cohort study. ; Setting ; 12 PICUs in North Carolina. ; Patients ; All children less than or equal to 24 months with traumatic brain injury, admitted to an included PICU ; Interventions ; None ; Measurement and Main Results ; Use of intracranial pressure monitors and treatments for elevated intracranial pressure were evaluated in 238 children with traumatic brain injury. Intracranial pressure monitoring (RR 3.7, 95%CI 1.5-9.3) and intracranial pressure therapies were more common in children with GCS less than or equal to 8 compared to GCS greater than 8. However, only 17% of children with GCS less than or equal to 8 received a monitoring device. Treatments for elevated intracranial pressure were more common in children with monitors; yet, some children without monitors received therapies traditionally used to lower intracranial pressure. Unadjusted predictors of monitoring were GCS less than or equal to 8, receipt of cardiopulmonary resuscitation, non-white race. Logistic-regression showed no strong predictors of intracranial pressure monitor use. Compared to the 2000 cohort, children in the 2010 cohort with GCS less than or equal to 8 were less likely to receive monitoring (RR 0.5, 95% CI 0.3-1.0), although the estimate was not precise, or intracranial pressure management therapies. ; Conclusion ; Children in the 2010 cohort with a GCS less than or equal to 8 were less likely to receive an intracranial pressure monitor or hyperosmolar therapy than children in the 2000 cohort; however, about 10% of children without monitors received therapies to decrease intracranial pressure. This suggests treatment heterogeneity in children less than or equal to 24 months with traumatic brain injury and a need for better evidence to support treatment recommendations for this group of children.
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• Subjects:
  • Brain Injuries, Traumatic
  • Child, Preschool
  • Critical Care
  • Female
  • Guideline Adherence
  • Humans
  • Infant
  • Infant, Newborn
  • Intensive Care Units, Pediatric
  • Intracranial Hypertension
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• Keywords:
  • pediatrics, traumatic brain injury
  • intracranial pressure
  • intracranial hypertension
  • brain edema
  • inflicted head injury
• Source:
  Pediatr Crit Care Med. 17(11):1064-1072
• Pubmed ID:
  27632060
• Pubmed Central ID:
  PMC5257177
• Document Type:
  Text
• Funding:
  U49 CE001275/CE/NCIPC CDC HHSUnited States/
• Genre:
  Journal Article
• Place as Subject:
  North Carolina
• Volume:
  17
• Issue:
  11
• Download URL:
  https://stacks.cdc.gov/view/cdc/43936/cdc_43936_DS1.pdf
• File Type:
  [PDF - 350.59 KB]
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha-512:572f2c2cdc72f57cac61b0143cb81ded469fde8e1d99c0393b086e09af38b92e73f07cb5666ffc21ef51cbaf6ddb0be2efed4490f22e733a790531c62dbbe672