Pediatric Intracranial Pressure Surveillance and Quantitative Outcomes in Kids: (PIPSQK) Study
Ryan Wan1, Madison Morgan2, *Lindsey L. Perea2
1Philadelphia College of Osteopathic Medicine, Philadelphia, PA; 2Penn Medicine Lancaster General Hospital, Lancaster, PA
BACKGROUND: Intracranial pressure (ICP) monitoring in pediatric traumatic brain injury (TBI) patients remains controversial. We aimed to characterize the impact of ICP monitoring on mortality for pediatric severe TBI. We hypothesize ICP monitoring would not improve survival.METHODS: Pediatric patients (≤14 years) presenting to Pennsylvania trauma centers from 2003-2018 who met severe brain injury criteria (Glasgow Coma Score [GCS] <8 and Head Abbreviated Injury Scale [AIS] 4-5) were included. Patients presenting dead on arrival and transfer patients were excluded. Patients were categorized according to ICP monitor placement (ICP+ and ICP-). To assess the effects of ICP monitors on mortality, a multivariate logistic regression model adjusting for demographics and injury patterns was performed.RESULTS: A total of 1,029 pediatric patients met inclusion criteria. Of those, 23.2% were in ICP+ group (n=239) and overall mortality was 42.18% (n=434). Despite a higher Injury Severity Score in ICP+ compared to ICP- (33.2± 9.4 v. 29.2±18.45, p= 0.013), the mortality rate was lower (23.0% v. 47.9%, p <0.001). The ICP+ group had lower functional statuses at discharge (FSD) (10.29±5.7 vs 15.51±5.5, p<0.001) (Table 1). However, on multivariate logistic regression, ICP+ was not significantly associated with mortality (adjusted odds ratio [AOR] 0.94, p=0.812). CONCLUSION: While ICP monitor placement remains controversial in pediatric trauma, there may be a survival advantage, despite lower functional status at discharge.
|Patients with ICP monitor (n=239)||Patients without ICP monitor (n= 790)||p-value|
|SexMale (%)||150 (62.8%)||497 (62.9%)||p = 0.966|
|Age (years)Mean||8.02± 4.9||7.13± 4.8||p=0.013|
|Mortality||55 (23.0%)||379 (47.9%)||p<0.001|
|Mechanism of Injury:Blunt||230 (96.2%)||603 (76.3%)||p < 0.001|
|CraniotomyYes||101 (42.4%)||91 (11.6%)||p < 0.001|
Table 1. Characteristics of the population.
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