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Intracranial pressure monitoring associated with increased mortality in pediatric brain injuries

Abstract

Background

Utilization of ICP monitors for pediatric patients is low and varies between centers. We hypothesized that in more severely injured patients (GCS 3–4), there would be a decreased mortality associated with invasive monitoring devices.

Methods

The pediatric Trauma Quality Improvement Program (TQIP) was queried for patients aged ≤ 16 years meeting criteria for invasive monitors. Our primary outcome was mortality. Patients with ICP monitoring were compared to those without. A logistic regression was used to examine the risk of mortality.

Results

Of 3,808 patients, 685 (18.0%) underwent ICP monitoring. ICP monitors were associated with increased risk of mortality (OR 1.82, CI 1.36–2.44, p < 0.001). A secondary analysis including type of invasive ICP monitor and dividing GCS into 3 categories revealed both intraventricular drain (OR 1.89, CI 1.3–2.7, p = 0.001) and intraparenchymal pressure monitor (OR 1.86, CI 1.32–2.6, p < 0.001) to be independently associated with an increased likelihood of mortality regardless of GCS, while intraparenchymal oxygen monitoring was not (OR 0.47, CI 0.11–2.05, p = 0.316). The strongest effect was seen in those patients with a GCS of 5–6.

Conclusion

ICP monitors are an independent risk factor for mortality, particularly with intraventricular drains and intraparenchymal monitors in patients with a GCS 5–6.

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Correspondence to Patrick T. Delaplain.

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None of the authors of this manuscript has any significant financial conflicts of interest to disclose.

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This study was determined to be IRB exempt by the IRB Board at the University of California, Irvine. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Delaplain, P.T., Grigorian, A., Lekawa, M. et al. Intracranial pressure monitoring associated with increased mortality in pediatric brain injuries. Pediatr Surg Int (2020). https://doi.org/10.1007/s00383-020-04618-y

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Keywords

  • Pediatric trauma
  • Traumatic brain injury (TBI)
  • Intracranial pressure (ICP) monitor
  • Intracranial hypertension