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Intracranial Pressure Monitoring in Infants and Young Children With Traumatic Brain Injury

Dixon, Rebecca R. MD; Nocera, Maryalice RN, MSN; Zolotor, Adam J. MD, DrPH; Keenan, Heather T. MDCM, PhD

doi: 10.1097/PCC.0000000000000937
Neurocritical Care
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Objective: To examine the use of intracranial pressure monitors and treatment for elevated intracranial pressure in children 24 months old or younger with traumatic brain injury in North Carolina between April 2009 and March 2012 and compare this with a similar cohort recruited 2000–2001.

Design: Prospective, observational cohort study.

Setting: Twelve PICUs in North Carolina.

Patients: All children 24 months old or younger with traumatic brain injury, admitted to an included PICU.

Interventions: None.

Measurement and Main Results: The use of intracranial pressure monitors and treatments for elevated intracranial pressure were evaluated in 238 children with traumatic brain injury. Intracranial pressure monitoring (risk ratio, 3.7; 95% CI, 1.5–9.3) and intracranial pressure therapies were more common in children with Glasgow Coma Scale less than or equal to 8 compared with Glasgow Coma Scale greater than 8. However, only 17% of children with Glasgow Coma Scale less than or equal to 8 received a monitoring device. Treatments for elevated intracranial pressure were more common in children with monitors; yet, some children without monitors received therapies traditionally used to lower intracranial pressure. Unadjusted predictors of monitoring were Glasgow Coma Scale less than or equal to 8, receipt of cardiopulmonary resuscitation, nonwhite race. Logistic regression showed no strong predictors of intracranial pressure monitor use. Compared with the 2000 cohort, children in the 2010 cohort with Glasgow Coma Scale less than or equal to 8 were less likely to receive monitoring (risk ratio, 0.5; 95% CI, 0.3–1.0), although the estimate was not precise, or intracranial pressure management therapies.

Conclusion: Children in the 2010 cohort with a Glasgow Coma Scale less than or equal to 8 were less likely to receive an intracranial pressure monitor or hyperosmolar therapy than children in the 2000 cohort; however, about 10% of children without monitors received therapies to decrease intracranial pressure. This suggests treatment heterogeneity in children 24 months old or younger with traumatic brain injury and a need for better evidence to support treatment recommendations for this group of children.

Supplemental Digital Content is available in the text.

1Pediatric Critical Care, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT.

2University of North Carolina Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC.

3Department of Family Medicine, University of North Carolina School of Medicine, Chapel Hill, NC.

This work was performed at The University of Utah School of Medicine, Salt Lake City, UT and The University of North Carolina School of Medicine, Chapel Hill, NC.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/pccmjournal).

Supported, in part, by a grant to Dr. Zolotor from the Centers for Disease Control and Prevention, National Center for Injury Prevention and Control (5U49CE001275).

Ms. Nocera received support for article research from Centers for Disease Control and Prevention (CDC) National Center for Injury Prevention. Her institution received funding from CDC NCIPC. Dr. Zolotor’s institution receives grants which support his work and a portion of his salary from the following entities: the Duke Endowment, Blue Cross Blue Shield of NC Foundation, Kate B Reynolds Charitable Trust, and the Winston-Salem Foundation. His institution received funding from the CDC and the Duke Endowment. Dr. Keenan received funding as a paid consultant to the grant that generated these data (Shaken Baby Prevention grant from the CDC to the University of North Carolina [principal investigator [PI], Dr. Zolotar]). She received support for article research from the CDC as a consultant for this grant (co-author Dr. Zolotar was the PI), and received funding from the National Institute of Child Health and Human Development (NICHD) (travel/accommodations/and honorarium). Her institution received funding from NICHD (Dr. Keenan has two grants from the CDC). Dr. Dixon disclosed that she does not have any potential conflicts of interest.

For information regarding this article, E-mail: Rebecca.Dixon@hsc.utah.edu

©2016The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies