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Under pressure: Identifying factors for pediatric patients with severe traumatic brain injury who benefit from

Erin West1, Utsav M Patwardhan1, Richard Calvo2

  • 1Rady Children's Hospital, 3020 Children's Way, San Diego, CA, 92123, USA.

Journal of Pediatric Surgery
|August 13, 2025
PubMed

Insights

External ventricular drainage (EVD) in pediatric traumatic brain injury (TBI) management shows improved outcomes. Patients with severe TBI benefit from EVD, especially when treated at centers with higher EVD utilization rates.

Area of Science:

  • Neurosurgery
  • Pediatric Critical Care
  • Trauma Surgery

Background:

  • External ventricular drainage (EVD) plays a crucial role in managing severe pediatric traumatic brain injury (TBI).
  • EVD management strategies are evolving, with recent data suggesting better outcomes compared to intracranial pressure (ICP) monitoring alone.
  • Discrepancies exist between current clinical guidelines and actual practice regarding EVD use in pediatric TBI.

Purpose of the Study:

  • To identify pediatric TBI patients who most benefit from external ventricular drainage (EVD) placement.
  • To analyze the impact of EVD on discharge disposition in severe pediatric TBI.
  • To investigate factors influencing outcomes in children treated with EVD for TBI.

Main Methods:

  • Retrospective cohort study using the Trauma Quality Improvement Program (TQIP) database (2016-2022).
  • Included children (<16 years) with severe blunt TBI (GCS ≤8) receiving EVD within 48 hours of admission.
  • Multivariate analyses using stratified competing risk survival models to assess discharge disposition.

Main Results:

  • A total of 898 pediatric TBI patients were analyzed; 21.6% experienced mortality.
  • Higher Injury Severity Score (ISS) and cerebral edema were associated with adverse discharge outcomes.
  • Epidural hematoma and higher center EVD utilization rates were linked to favorable discharge disposition.

Conclusions:

  • Injury severity and cerebral edema are key predictors of mortality or hospice discharge post-EVD.
  • Pediatric TBI patients treated at centers with higher EVD utilization show improved likelihood of returning home.
  • EVD remains a critical intervention, with outcomes influenced by patient-specific factors and center-level practices.
Abstract

Keywords:
DischargeExternal ventricular drainageIntracranial hypertensionPediatric traumatic brain injuryTrauma quality programVentriculostomy

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