Background: Severe traumatic brain injury (sTBI) is the leading cause of morbidity and mortality from trauma. Brain Trauma Foundation guidelines recommend intracranial pressure (ICP) monitoring in sTBI. We hypothesized that early ICP monitor placement was associated with better outcomes in children. Methods: This was a retrospective study of children with sTBI admitted to the participating pediatric intensive care units (PICUs) and entered into the Virtual Pediatric Systems (VPS), LLC, database between 1 January 2010 and 31 December 2015. We compared outcomes of patients who had an ICP monitor placed early (≤6 h from PICU admission) to those with later placement (> 6 to < 72 h). We collected demographics, diagnoses, procedure data, illness severity scores, outcomes, and site data. Multivariable regression analysis was used to identify variables independently associated with outcomes. Results: Twenty-seven percent of 3,608 patients with sTBI underwent ICP monitoring, 355 in the early and 156 in the later ICP monitoring groups, respectively. A higher proportion of patients in the early ICP monitoring group had worse markers of illness/injury severity; unadjusted analysis showed higher mortality in this group (31.3 vs. 21.8%, p = 0.029). Multivariable regression analysis showed that ICP monitoring was not independently associated with any of the outcomes. Conclusion: Time to ICP monitoring was not associated with outcomes after pediatric sTBI.

1.
Centers for Disease Control and Prevention
. Injury Prevention and Control: Traumatic Brain Injury & Concussion.
2016
. Available at: http://www.cdc.gov/traumaticbraininjury/severe.html
2.
Carney
N
,
Totten
AM
,
O’Reilly
C
,
Ullman
JS
,
Hawryluk
GW
,
Bell
MJ
, et al
Guidelines for the Management of Severe Traumatic Brain Injury, Fourth Edition
.
Neurosurgery
.
2017
Jan
;
80
(
1
):
6
15
.
[PubMed]
1524-4040
3.
Kochanek
PM
,
Carney
N
,
Adelson
PD
,
Ashwal
S
,
Bell
MJ
,
Bratton
S
, et al;
World Federation of Pediatric Intensive and Critical Care Societies
.
Guidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents—second edition
.
Pediatr Crit Care Med
.
2012
Jan
;
13
Suppl 1
:
S1
82
.
[PubMed]
1529-7535
4.
Fakhry
SM
,
Trask
AL
,
Waller
MA
,
Watts
DD
,
IRTC Neurotrauma Task Force
. Management of brain-injured patients by an evidence-based medicine protocol improves outcomes and decreases hospital charges. J Trauma.
2004
Mar;56(3):492,9; discussion 499-500
5.
Pineda
JA
,
Leonard
JR
,
Mazotas
IG
,
Noetzel
M
,
Limbrick
DD
,
Keller
MS
, et al
Effect of implementation of a paediatric neurocritical care programme on outcomes after severe traumatic brain injury: a retrospective cohort study
.
Lancet Neurol
.
2013
Jan
;
12
(
1
):
45
52
.
[PubMed]
1474-4422
6.
O’Lynnger
TM
,
Shannon
CN
,
Le
TM
,
Greeno
A
,
Chung
D
,
Lamb
FS
, et al
Standardizing ICU management of pediatric traumatic brain injury is associated with improved outcomes at discharge
.
J Neurosurg Pediatr
.
2016
Jan
;
17
(
1
):
19
26
.
[PubMed]
1933-0707
7.
Alali
AS
,
Fowler
RA
,
Mainprize
TG
,
Scales
DC
,
Kiss
A
,
de Mestral
C
, et al
Intracranial pressure monitoring in severe traumatic brain injury: results from the American College of Surgeons Trauma Quality Improvement Program
.
J Neurotrauma
.
2013
Oct
;
30
(
20
):
1737
46
.
[PubMed]
0897-7151
8.
Alali
AS
,
Gomez
D
,
Sathya
C
,
Burd
RS
,
Mainprize
TG
,
Moulton
R
, et al
Intracranial pressure monitoring among children with severe traumatic brain injury
.
J Neurosurg Pediatr
.
2015
Nov
;
16
(
5
):
523
32
.
[PubMed]
1933-0707
9.
Agrawal
D
,
Raghavendran
K
,
Schaubel
DE
,
Mishra
MC
,
Rajajee
V
.
A Propensity Score Analysis of the Impact of Invasive Intracranial Pressure Monitoring on Outcomes after Severe Traumatic Brain Injury
.
J Neurotrauma
.
2016
May
;
33
(
9
):
853
8
.
[PubMed]
0897-7151
10.
Dawes
AJ
,
Sacks
GD
,
Cryer
HG
,
Gruen
JP
,
Preston
C
,
Gorospe
D
, et al
Intracranial pressure monitoring and inpatient mortality in severe traumatic brain injury: A propensity score-matched analysis. J Trauma Acute Care Surg.
2015
Mar;78(3): 492,501; discussion 501-2.
11.
Alkhoury
F
,
Kyriakides
TC
.
Intracranial Pressure Monitoring in Children With Severe Traumatic Brain Injury: National Trauma Data Bank-Based Review of Outcomes
.
JAMA Surg
.
2014
Jun
;
149
(
6
):
544
8
.
[PubMed]
2168-6254
12.
Bennett
TD
,
DeWitt
PE
,
Greene
TH
,
Srivastava
R
,
Riva-Cambrin
J
,
Nance
ML
, et al
Functional Outcome After Intracranial Pressure Monitoring for Children With Severe Traumatic Brain Injury
.
JAMA Pediatr
.
2017
Oct
;
171
(
10
):
965
71
.
[PubMed]
2168-6203
13.
Biersteker
HA
,
Andriessen
TM
,
Horn
J
,
Franschman
G
,
van der Naalt
J
,
Hoedemaekers
CW
, et al
Factors influencing intracranial pressure monitoring guideline compliance and outcome after severe traumatic brain injury
.
Crit Care Med
.
2012
Jun
;
40
(
6
):
1914
22
.
[PubMed]
0090-3493
14.
Chesnut
RM
,
Temkin
N
,
Carney
N
,
Dikmen
S
,
Rondina
C
,
Videtta
W
, et al;
Global Neurotrauma Research Group
.
A trial of intracranial-pressure monitoring in traumatic brain injury
.
N Engl J Med
.
2012
Dec
;
367
(
26
):
2471
81
.
[PubMed]
0028-4793
15.
Forsyth
RJ
,
Raper
J
,
Todhunter
E
.
Routine intracranial pressure monitoring in acute coma.
Cochrane Database Syst Rev.
2015
Nov 2;(11):CD002043. doi (11):CD002043.
16.
Yuan
Q
,
Wu
X
,
Sun
Y
,
Yu
J
,
Li
Z
,
Du
Z
, et al
Impact of intracranial pressure monitoring on mortality in patients with traumatic brain injury: a systematic review and meta-analysis
.
J Neurosurg
.
2015
Mar
;
122
(
3
):
574
87
.
[PubMed]
0022-3085
17.
Leventhal
JM
,
Martin
KD
,
Gaither
JR
.
Using US data to estimate the incidence of serious physical abuse in children
.
Pediatrics
.
2012
Mar
;
129
(
3
):
458
64
.
[PubMed]
0031-4005
18.
Fiser
DH
.
Assessing the outcome of pediatric intensive care
.
J Pediatr
.
1992
Jul
;
121
(
1
):
68
74
.
[PubMed]
0022-3476
19.
Fiser
DH
,
Tilford
JM
,
Roberson
PK
.
Relationship of illness severity and length of stay to functional outcomes in the pediatric intensive care unit: a multi-institutional study
.
Crit Care Med
.
2000
Apr
;
28
(
4
):
1173
9
.
[PubMed]
0090-3493
20.
Elze
MC
,
Gregson
J
,
Baber
U
,
Williamson
E
,
Sartori
S
,
Mehran
R
, et al
Comparison of Propensity Score Methods and Covariate Adjustment: Evaluation in 4 Cardiovascular Studies
.
J Am Coll Cardiol
.
2017
Jan
;
69
(
3
):
345
57
.
[PubMed]
0735-1097
21.
Ali
MS
,
Groenwold
RH
,
Belitser
SV
,
Pestman
WR
,
Hoes
AW
,
Roes
KC
, et al
Reporting of covariate selection and balance assessment in propensity score analysis is suboptimal: a systematic review
.
J Clin Epidemiol
.
2015
Feb
;
68
(
2
):
112
21
.
[PubMed]
0895-4356
22.
Sharples
PM
,
Stuart
AG
,
Matthews
DS
,
Aynsley-Green
A
,
Eyre
JA
.
Cerebral blood flow and metabolism in children with severe head injury. Part 1: relation to age, Glasgow coma score, outcome, intracranial pressure, and time after injury
.
J Neurol Neurosurg Psychiatry
.
1995
Feb
;
58
(
2
):
145
52
.
[PubMed]
0022-3050
23.
Davidson
GH
,
Maier
RV
,
Arbabi
S
,
Goldin
AB
,
Rivara
FP
.
Impact of operative intervention delay on pediatric trauma outcomes
.
J Trauma Acute Care Surg
.
2012
Jul
;
73
(
1
):
162
7
.
[PubMed]
2163-0755
24.
Bell
RS
,
Mossop
CM
,
Dirks
MS
,
Stephens
FL
,
Mulligan
L
,
Ecker
R
, et al
Early decompressive craniectomy for severe penetrating and closed head injury during wartime
.
Neurosurg Focus
.
2010
May
;
28
(
5
):
E1
.
[PubMed]
1092-0684
25.
Shafi
S
,
Barnes
SA
,
Millar
D
,
Sobrino
J
,
Kudyakov
R
,
Berryman
C
, et al
Suboptimal compliance with evidence-based guidelines in patients with traumatic brain injuries
.
J Neurosurg
.
2014
Mar
;
120
(
3
):
773
7
.
[PubMed]
0022-3085
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