Intracranial Pressure Monitoring in Pediatric Traumatic Brain Injury Patients: A National Study

We aimed to evaluate whether intracranial pressure (ICP) monitoring is associated with improved survival outcomes in pediatric patients with traumatic brain injury (TBI) and to identify subgroups of children who may derive the greatest benefit.

We reviewed the American College of Surgeons Trauma Quality Improvement Program (17-22) to identify cases of isolated pediatric TBI (<18 y). Exclusion criteria were hospital length of stay (LOS) < 1 d, Abbreviated Injury Scale ≥3 in other regions and those who received ICP monitoring after craniotomy/craniectomy. Patients were dichotomized into ICP and NoICP. Propensity score match was performed to adjust for age (<2, 2-5, 6-12, and 13-17 y), sex, race, head Abbreviated Injury Scale , Glasgow Coma Scale (3-8, 9-12, and 13-15), craniotomy/craniectomy status, type of intracranial bleed, number of distinct bleeds, and pupillary response. Primary outcome was mortality. Secondary outcomes were in-hospital complications, hospital and intensive care unit LOS. Two subanalyses stratifying the population by age and Glasgow Coma Scale were performed using multivariable logistic regression.

Of 29,645 cases included, 1269 underwent ICP monitoring. After propensity score match, 1250 remained in each group. ICP had lower in-hospital mortality (17.3% versus 22.7%, P < 0.001) and higher complications including acute kidney injury, deep vein thrombosis, unplanned return to operating room, ventilator-associated pneumonia and pressure ulcer. ICP also had a significantly longer intensive care unit LOS, ventilator days, and hospital LOS.

ICP monitoring was associated with a significant reduction in mortality in pediatric TBI. Our findings suggest that the benefit of ICP monitoring is not uniform and may be limited to selecting high-risk populations.