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Evaluating the Benefits of Ventriculostomy Compared to Intracranial Pressure Monitoring for Severe Pediatric
Utsav M Patwardhan1, Richard Calvo2, Laurinda Jackson3
1Naval Medical Center San Diego, 34800 Bob Wilson Dr, San Diego, CA 92134, USA; Rady Children's Hospital San Diego, 3020 Children's Way, San Diego, CA 92123, USA.
Insights
Ventriculostomy (VT) in pediatric trauma patients with severe TBI was associated with higher rates of discharge home compared to intracranial pressure monitoring (ICP) alone. VT did not increase mortality but resulted in a longer length of stay.
Area of Science:
- Neurosurgery
- Trauma Surgery
- Pediatric Critical Care
Background:
- Severe traumatic brain injury (TBI) in pediatric patients requires effective intracranial pressure (ICP) management.
- Intracranial pressure monitoring (ICP) and ventriculostomy (VT) are key interventions.
- Comparing outcomes between ICP monitoring alone and ICP with VT is crucial for optimizing pediatric TBI care.
Purpose of the Study:
- To compare patient outcomes between ICP monitoring only and ICP with ventriculostomy (VT) in a nationwide cohort of pediatric trauma patients.
- To evaluate the association of ICP versus VT with discharge disposition, subsequent intracranial surgery, length of stay, and infectious complications.
Main Methods:
- Retrospective analysis of the 2017-2021 ACS Trauma Quality Programs database.
- Inclusion of pediatric patients (<18 years) with severe blunt TBI.
- Exclusion of patients with death or craniotomy/craniectomy within 48 hours.
- Use of competing risks survival analysis to assess outcomes.
Main Results:
- Of 1719 eligible patients, 54.1% received VT.
- Ventriculostomy (VT) was robustly associated with discharge home (sHR 0.85, p=0.017).
- No significant differences were found in mortality (p=0.342), subsequent craniotomy/craniectomy (p=0.096), or infectious complications (p=0.549).
- VT patients experienced a longer median length of stay (20.5 vs. 18.0 days, p<0.001).
Conclusions:
- Ventriculostomy (VT) is associated with improved discharge disposition to home in pediatric TBI patients.
- Despite a longer length of stay, VT does not increase the risk of mortality, further surgery, or infections.
- VT may offer benefits in managing severe TBI, particularly regarding functional recovery and discharge destination.
Background:
In this study, we compared outcomes between intracranial pressure monitoring (ICP) only versus ventriculostomy (VT) using a nationwide database of pediatric trauma patients.
Methods:
Pediatric patients (<18 years) with severe blunt TBI who underwent ICP monitoring with or without VT were identified from the 2017-2021 ACS Trauma Quality Programs. We excluded patients who experienced death or craniotomy/craniectomy within 48 h. The primary outcome was discharge disposition. Secondary outcomes were subsequent intracranial surgery, length of stay (LOS), and infectious complications. Competing risks survival analysis was used to evaluate the multivariable association between ICP vs. VT and outcomes.
Results:
Of 1719 eligible patients, 65.9% were male and 54.1% had VT. Between the ICP and VT groups, there were no differences in mean age (11.4 vs. 11.0 years, p = 0.145), injury severity score (30.9 vs. 30.9, p = 0.937), or median GCS (3 vs. 3, p = 0.120). Multivariable analysis showed a robust association between VT and discharge home (compared to rehabilitation center; sHR 0.85, 95% CI 0.74-0.97, p = 0.017). VT use was not associated with increased mortality compared to ICP (p = 0.342). Finally, VT patients had longer median LOS (20.5 vs. 18.0 days, p < 0.001) but there was no difference in subsequent craniotomy/craniectomy (8.6 vs. 6.5%, p = 0.096) or infectious complications (1.2 vs. 0.9%, p = 0.549).
Conclusion:
VT was associated with greater discharge to home. Although VT patients had a greater LOS, the risk for other secondary outcomes did not vary, suggesting that VT may have benefits for the treatment of severe TBI with respect to discharge disposition.
Level Of Evidence:
III.
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