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Early Intracranial Pressure Monitoring and Outcomes in Severe Pediatric Traumatic Brain Injury
S Pan, MD, N Kannan, MD, J Wang, PhD, DF Zatzick, MD, RG Ellenbogen, MD, LN Boyle, PhD, PH Mitchell, PhD, FP Rivara, MD, MPH, A Rowhani-Rahbar, MD, MPH, PhD and MS Vavilala, MD, University of Washington, Seattle WA; RB Mink, MD, MACM, Harbor-UCLA and Los Angeles Biomedical Research Institute, Torrance CA; MS Wainwright, MD, PhD, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago IL; JI Groner, MD, Ohio State University College of Medicine Columbus OH; MJ Bell, MD, University of Pittsburgh, Pittsburgh PA; CC Giza, MD, Mattel Children's Hospital, UCLA, Los Angeles CA

Abstract:
Background The relationship between intracranial pressure (ICP) monitoring and outcomes in patients with severe traumatic brain injury (TBI) remains unclear. We aimed to examine the effect of intracranial pressure monitoring during early care (in the Emergency department on outcomes in children with severe TBI. Methods A retrospective multicenter cohort study encompassing five regional pediatric trauma centers affiliated with academic medical centers examined children under 18 years with severe TBI (admission Glasgow Coma Scale score ? 8, ICD-9 diagnosis codes of 800.0-801.9, 803.0-804.9, 850.0-854.1, 959.01, 950.1-950.3, 995.55, maximum head abbreviated Injury Severity Score ? 3) who received tracheal intubation for at least 48 hours in the ICU between 2007 and 2011. The main outcomes were in-hospital mortality and Discharge Glasgow Outcome Scale (GOS) score. Results Among the 224 patients admitted to the ED, 62 (28%) patients had ICP monitoring. Of those who had ICP monitoring in the ED, 50 (81%) had early ICP placement (within 4 hours of admission to ED). There was a trend towards lower in-hospital mortality with any ED ICP monitoring (aRR 0.56; 95% CI: 0.30, 1.05, p = 0.07) after adjusting for possible confounders. There was no significant difference in discharge GOS scores between patients who had any ED ICP monitoring as compared to those who did not (aRR 1.21; 95% CI: 0.85, 1.71). Conclusions The frequency of ED ICP placement and monitoring is low and yet, ICP monitoring initiated in the ED may be associated with lower in-hospital mortality in children with severe TBI.
Objective:
At the end of this presentation, I would be able to discuss my results and conclusions on the research question that we set to examine: whether early intracranial pressure monitoring had an impact on discharge outcomes in children with severe traumatic brain injury (TBI).
Objective: At the end of this presentation, I would be able to discuss my results and conclusions on the research question that we set to examine: whether early intracranial pressure monitoring had an impact on discharge outcomes in children with severe traumatic brain injury (TBI).
Objective Content: Alkoury & Kyriakides showed that intracranial pressure (ICP) monitoring in severe pediatric head injuries is not associated with improved survival but this study does not address the timing of ICP pressure monitoring. There have been no studies so far on the use of Emergency Department(ED) intracranial pressure monitoring in children with severe TBI. We hypothesized that intracranial pressure monitoring in the ED would be associated with better discharge outcomes in children with severe TBI. References: 1. Alkhoury F, Kyriakides TC. Intracranial Pressure Monitoring in Children With Severe Traumatic Brain Injury: National Trauma Data Bank-Based Review of Outcomes. JAMA Surg. 2014 Apr 30; PubMed PMID: 24789426. 2. Bennett TD, Riva-Cambrin J, Keenan HT, Korgenski EK, Bratton SL. Variation in intracranial pressure monitoring and outcomes in pediatric traumatic brain injury. Arch Pediatr Adolesc Med. 2012 Jul 1; 166(7):641-7. PubMed PMID: 22751878. 3. Adelson PD, Bratton SL, Carney NA, et al. Guidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents. Pediatr Crit Care Med. 2003 Jul; 4(3 Suppl):S1�75.


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