Related Experiment Video

Updated: Jun 6, 2026

A Multi-Modal Approach to Assessing Recovery in Youth Athletes Following Concussion
10:31

A Multi-Modal Approach to Assessing Recovery in Youth Athletes Following Concussion

Published on: September 25, 2014

Severe head injury in children: intensive care unit activity and mortality in England and Wales

Robert C Tasker1, Thomas J Fleming, Amber Er Young

  • 1Department of Paediatrics, Cambridge University Clinical School, Addenbrooke's Hospital, Cambridge, UK. rct31@cam.ac.uk

British Journal of Neurosurgery
|November 19, 2010
PubMed

Insights

Paediatric intensive care unit (PICU) head injury (HI) admissions in England and Wales showed that lowest-volume PICUs with limited neurosurgical practice had worse outcomes. Mid-volume PICUs demonstrated the best performance, not a direct volume-outcome relationship.

Area of Science:

  • Pediatric critical care medicine
  • Neurosurgery
  • Health services research

Background:

  • Paediatric intensive care unit (PICU) volume and specialist neurosurgical practice are potential factors influencing outcomes for children with head injuries (HI).
  • Understanding the relationship between PICU characteristics and patient outcomes is crucial for optimizing care delivery.

Purpose of the Study:

  • To investigate the association between the volume of paediatric intensive care unit (PICU) head injury (HI) admissions, the presence of specialist paediatric neurosurgical practice, and patient mortality in England and Wales.
  • To determine if PICU admission volume correlates with risk-adjusted mortality for paediatric head injuries.

Main Methods:

  • Analysis of 2575 paediatric (<16 years) head injury admissions to 27 PICUs in England and Wales between 2004-2008 using the Paediatric Intensive Care Audit Network.
  • Risk-adjusted mortality was assessed using the Paediatric Index of Mortality (PIM) model and stratified by PICU volume quartiles (highest to lowest HI admissions/year).
  • The impact of intensive care interventions (observation only, mechanical ventilation, intracranial pressure monitoring) on outcomes was examined in relation to specialist neurosurgical practice.

Main Results:

  • Overall PICU mortality for head injury was 9.3%.
  • Lowest-volume PICUs (fourth quartile) had minimal specialist paediatric neurosurgical activity and demonstrated worse-than-expected outcomes, particularly for patients undergoing intracranial pressure monitoring.
  • Performance hierarchy showed increasing effectiveness from lowest volume (Group IV) to medium-higher volume (Group II), highest volume (Group I), and medium-lower volume (Group III) PICUs.

Conclusions:

  • The UK's PICU system for critically ill children with head injuries generally performs as predicted by the PIM model.
  • Lowest-volume PICUs with limited paediatric neurosurgical capacity are associated with poorer outcomes.
  • Mid-volume PICUs achieved the best outcomes, suggesting that a simple volume-performance relationship does not fully explain outcomes in paediatric head injury care.
Abstract

More Related Videos

A Bedside, Single Burr Hole Approach to Multimodality Monitoring in Severe Brain Injury06:18

A Bedside, Single Burr Hole Approach to Multimodality Monitoring in Severe Brain Injury

Published on: March 26, 2019

Assessing Changes in Synaptic Plasticity Using an Awake Closed-Head Injury Model of Mild Traumatic Brain Injury09:49

Assessing Changes in Synaptic Plasticity Using an Awake Closed-Head Injury Model of Mild Traumatic Brain Injury

Published on: January 20, 2023

Related Concept Videos

Traumatic Brain Injury l: Introduction01:28

Traumatic Brain Injury l: Introduction

DefinitionTraumatic brain injury, or TBI, is a disturbance of normal brain function induced by an external mechanical force, such as a direct blow to the head or a penetrating injury. It can affect both brain structure and function, producing a wide range of clinical outcomes. TBI is a heterogeneous condition, meaning its effects may differ based on the type, location, and severity of the injury.Basis of ClassificationTBI is classified based on severity, injury mechanism, or pathophysiology. In...
Increased Intracranial Pressure l: Introduction01:14

Increased Intracranial Pressure l: Introduction

Intracranial hypertension is a sustained elevation of intracranial pressure (ICP) above 22 mm Hg. In supine adults, normal ICP is ~7–15 mm Hg.The rigid, nonexpandable cranium contains three components—brain tissue, blood, and cerebrospinal fluid (CSF)—that total ~1,700 mL in a typical adult: 1,400 mL brain (~80%), 150 mL blood (~10%), and 150 mL CSF (~10%). According to the Monro–Kellie doctrine, total intracranial volume is effectively fixed. When one component expands, CSF and venous blood...
Bacterial Meningitis I: Introduction01:22

Bacterial Meningitis I: Introduction

Bacterial meningitis is a severe, life-threatening inflammation of the meninges, particularly the pia mater and arachnoid mater, affecting the subarachnoid space, ventricles, and cerebrospinal fluid (CSF). If untreated, it can lead to significant neurological complications or death.Causative AgentsCommon pathogens vary with age and immune status. In adults, major organisms include Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenzae. Streptococcus agalactiae (group B...
Increased Intracranial Pressure ll: Pathophysiology01:29

Increased Intracranial Pressure ll: Pathophysiology

Increased intracranial pressure (ICP) refers to a potentially life-threatening rise in pressure inside the skull. This usually happens when there is a major change in the volume of brain tissue, blood, or cerebrospinal fluid (CSF) — the three components inside the skull. According to the Monro-Kellie doctrine, if the volume of one component increases, the volumes of the other components must decrease to maintain normal pressure. If this does not happen, ICP rises.The process often begins with...