Pediatric Trauma Society

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Impact of Timing of Placement of Intracranial Pressure Monitor on Outcomes in Children with Severe Traumatic Brain Injury
Binod Balakrishnan, Liyun Zhang, Pippa M Simpson, *Sheila J Hanson
Medical College of Wisconsin, Wauwatosa, WI


Background: Severe traumatic brain injury (sTBI) is the leading cause of morbidity and mortality from trauma in adults and children. Brain Trauma Foundation guidelines recommend use of intracranial pressure (ICP) monitoring in sTBI. We examined whether early ICP monitor placement was associated with better outcomes in children.Methods: This was a retrospective study of children 0-18 years with sTBI, in the Virtual PICU Systems (VPS), LLC database, admitted to the participating PICUs between 1/1/2010 and 12/31/2015. We compared outcomes of patients who had ICP monitor placed prior to or within 6 hours (early) from PICU admission to those with later monitor placement. Chi-square or Fisher’s exact test was used to compare categorical variables and Mann Whitney test to compare differences of continuous/ordinal variables between the two groups. A two-sided p-value < 0.05 was considered significant. Findings: Among 1898 patients who survived ≥ 24 h, 33% underwent ICP monitoring. 509 vs 116 had early vs late ICP monitor placement respectively. The two groups did not differ in demographics, illness severity, or need for CPR prior to admission. Unadjusted analysis showed higher mortality in the early group (31% vs 21%, p=0.03) and worse discharge outcomes as shown in the table.Conclusions: In our unadjusted analysis, pending further multivariable regression analysis, early ICP monitor placement was associated with worse outcomes. Prospective studies will be required to study the impact of timing of ICP monitor placement on outcomes.

ICP monitor in ≤ 6 hrs
N=509
ICP monitor in > 6 hrs
N=116
p-value
Admission GCS , n (%)
- 3-5 (Coma)
- 6-8 (Stupor/Lethargy)
332 (69)
146 (31)
67 (62)
40 (37)
0.17
Pupillary reaction, n (%) (n=607)
Both reactive
One or Both nonreactive
280 (57)
215 (43)
75 (67)
37 (33)
0.044
Hypothermic therapy, n (%)53 (10)22 (19)0.011
Craniotomy, n (%)214 (42)36 (31)0.029
Mortality, n (%)157 (31)24 (21)0.030
Discharge POPC (n=346), median (IQR)5 (3, 6)4(3, 6)0.019
Discharge PCPC (n=346), median (IQR)5 (3, 6)4 (3, 6)0.043

IQR: Interquartile range


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