Pediatric intracranial pressure surveillance and quantitative outcomes in kids: (PIPSQK) Study

Abstract

Objectives Intracranial pressure (ICP) monitoring in pediatric traumatic brain injury (TBI) patients remains controversial. This study aimed to characterize the association between ICP monitoring and mortality for pediatric severe TBI, hypothesizing that ICP monitoring would not be associated with improved survival. Methods Pediatric patients (≤14 years) presenting to Pennsylvania trauma centers from 2003 to 2018 who met severe brain injury criteria (Glasgow Coma Score <9 and Head Abbreviated Injury Scale 4–5) and presented with a blunt mechanism of injury 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 802 pediatric patients met the inclusion criteria. Of those, 28.7% were in ICP+ group ( n = 230) and overall mortality was 33.9% ( n = 272). Despite a higher Injury Severity Score in ICP+ compared to ICP− (33 v. 27, p < 0.001), the mortality rate was lower (22% v. 39%, p < 0.001). The ICP+ group had lower functional statuses at discharge (8 v. 18, p < 0.001). The multivariate logistic regression revealed that presence of an ICP monitor significantly decreased odds of mortality (adjusted odds ratio:0.57, p = 0.027). Conclusion While ICP monitor placement remains controversial in pediatric trauma, there appears to be an association between ICP monitor placement and decreased mortality, despite the ICP monitor group having lower functional status at discharge.