No Benefit of Intracranial Pressure Monitoring for Pediatric Traumatic Brain Injury
About 2200 deaths and 35,000 hospitalizations of children are caused by TBI.
There is no apparent benefit of intracranial pressure (ICP) monitoring for improving functional survival among pediatric patients with severe traumatic brain injury (TBI), according to findings from a propensity-weighted effectiveness analysis published in JAMA Pediatrics.
Investigators performed a database analysis to determine whether placement of an ICP monitor was associated with significant improvement in functional survival in 3084 pediatric patients with severe TBI (defined using the International Classification of Diseases, 9th Revision, Clinical Modification diagnosis codes) across 30 US children's hospitals. Children younger than 18 years of age with severe TBI and a hospital stay longer than 24 hours and with nonmissing disposition were included. Primary composite outcome included hospital mortality, discharge to hospice, or survival with new gastrostomy and tracheostomy tube placement.
The primary outcome was experienced in 484 (15.7%) patients with TBI undergoing ICP monitoring. No difference was found between monitored and unmonitored patients with TBI with regard to functional survival following a propensity-weighted logistic regression model analysis. Additionally, there was no mortality difference between monitored and unmonitored patients in a prespecified secondary analysis (odds ratio 1.16; 95% CI, 0.89-1.50).
ICP monitoring vs no ICP monitoring was associated with significantly longer hospital length of stay (19 vs 6 days; P <.001). Patients undergoing ICP monitoring also had more days on pressors or inotropes (3 vs 2 days; P <.001) as well as more days on mechanical ventilation compared with nonmonitored patients (7 vs 2 days; P <.001).
The researchers noted that there was no information regarding the medical decisions which led to clinical events, representing one of the limitations of this analysis.
The investigators of this study mention that because there may have been a possibility of unmeasured confounding, the findings “should be interpreted as provocative, but we should not change the standard of care.”
Bennett TD, DeWitt PE, Greene TH, et al. Functional outcome after intracranial pressure monitoring for children with severe traumatic brain injury [published online August 28, 2017]. JAMA Pediatr. doi: 10.1001/jamapediatrics.2017.2127