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doi: 10.1227/NEU.0000000000000097
Research-Human-Clinical Studies: Editor's Choice

National Variability in Intracranial Pressure Monitoring and Craniotomy for Children With Moderate to Severe Traumatic Brain Injury

Van Cleve, William MD, MPH*; Kernic, Mary A. PhD, MPH; Ellenbogen, Richard G. MD§; Wang, Jin PhD; Zatzick, Douglas F. MD; Bell, Michael J. MD#; Wainwright, Mark S. MD, PhD**; Groner, Jonathan I. MD‡‡; Mink, Richard B. MD, MACM§§; Giza, Christopher C. MD¶¶; Boyle, Linda Ng PhD‖‖; Mitchell, Pamela H. PhD##; Rivara, Frederick P. MD, MPH; Vavilala, Monica S. MD*; for the PEGASUS (Pediatric Guideline Adherence and Outcomes) Project

Editor's Choice
Press Release
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BACKGROUND: Traumatic brain injury (TBI) is a significant cause of mortality and disability in children. Intracranial pressure monitoring (ICPM) and craniotomy/craniectomy (CRANI) may affect outcomes. Sources of variability in the use of these interventions remain incompletely understood.

OBJECTIVE: To analyze sources of variability in the use of ICPM and CRANI.

METHODS: Retrospective cross-sectional study of patients with moderate/severe pediatric TBI with the use of data submitted to the American College of Surgeons National Trauma Databank.

RESULTS: We analyzed data from 7140 children at 156 US hospitals during 7 continuous years. Of the children, 27.4% had ICPM, whereas 11.7% had a CRANI. Infants had lower rates of ICPM and CRANI than older children. A lower rate of ICPM was observed among children hospitalized at combined pediatric/adult trauma centers than among children treated at adult-only trauma centers (relative risk = 0.80; 95% confidence interval 0.66-0.97). For ICPM and CRANI, 18.5% and 11.6%, respectively, of residual model variance was explained by between-hospital variation in care delivery, but almost no correlation was observed between within-hospital tendency toward performing these procedures.

CONCLUSION: Infants received less ICPM than older children, and children hospitalized at pediatric trauma centers received less ICPM than children at adult-only trauma centers. In addition, significant between-hospital variability existed in the delivery of ICPM and CRANI to children with moderate-severe TBI.

ABBREVIATIONS: AIS, Abbreviated Injury Score

CRANI, craniotomy/craniectomy

GCS, Glasgow Coma Score

ICD-9-CM, International Classification of Diseases, Ninth Revision, Clinical Modification

ICP, intracranial pressure

ICPM, intracranial pressure monitoring

ISS, Injury Severity Score

NTDB, National Trauma Databank

TBI, traumatic brain injury

Copyright © by the Congress of Neurological Surgeons


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