Intracranial pressure monitoring associated with increased mortality in pediatric brain injuries
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In brief
In brief
Analysis of 3,808 pediatric trauma patients found ICP monitoring associated with 82% increased mortality risk, with strongest effect in moderate injury (GCS 5-6). Both intraventricular drains and intraparenchymal monitors showed independent mortality associations, suggesting monitoring may be a marker of injury severity rather than a protective intervention.
Written by the GCMD Library team from the article.
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.