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Epidemiology of Critical Interventions in Children With Traumatic Intracranial Hemorrhage

Pradip P Chaudhari, Jose Pineda, Richard G Bachur1

  • 1Division of Emergency Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA.

Pediatric Emergency Care
|March 29, 2021
PubMed

Insights

Critical medical interventions occurred in 10% of pediatric traumatic intracranial hemorrhage (ICH) cases, while neurosurgical interventions were less common at 3%. Resource utilization, including ICU admission and repeat imaging, is high, even in low-risk patients.

Area of Science:

  • Pediatric Traumatology
  • Neurocritical Care
  • Health Services Research

Background:

  • Traumatic intracranial hemorrhage (ICH) in children necessitates careful management and resource allocation.
  • Understanding intervention rates and resource utilization is crucial for optimizing pediatric neurocritical care.

Purpose of the Study:

  • To estimate the rates of critical medical and neurosurgical interventions for pediatric traumatic ICH.
  • To assess intensive care unit (ICU) admission and repeat neuroimaging rates in this population.
  • To identify factors associated with critical intervention use.

Main Methods:

  • Retrospective study of children (<18 years) with ICH using the Pediatric Health Information System (2009-2019).
  • Defined critical interventions as medical (e.g., hyperosmotic agents, intubation) or neurosurgical procedures.
  • Utilized hierarchical logistic regression to identify factors associated with critical interventions.

Main Results:

  • 12,714 children with ICH were analyzed; 12% received critical interventions (10% medical, 3% neurosurgical).
  • ICU admission occurred in 44% and repeat neuroimaging in 40% of patients.
  • A significant proportion of patients (79%) admitted to the ICU did not receive critical interventions; similar trends observed for repeat imaging.

Conclusions:

  • Critical medical and neurosurgical intervention rates in pediatric traumatic ICH are relatively low.
  • Intensive care unit admission and repeat neuroimaging are frequently utilized, even in children not requiring critical interventions.
  • Selective use of ICU resources and repeat imaging in low-risk pediatric ICH patients could enhance care quality and reduce costs.
Abstract

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