Intracranial Pressure Monitoring in Children With Severe Traumatic Brain Injury : National Trauma Data Bank–Based Review of Outcomes

IMPORTANCE The present study is the largest on the use and effect of intracranial pressure (ICP) monitoring in pediatric trauma patients. OBJECTIVE To determine the effect of ICP monitoring on survival in pediatric patients with severe head injuries using the National Trauma Data Bank. DESIGN, SETTING, AND PARTICIPANTS The National Trauma Data Bank was queried (version 6.2, 2001-2006) for information on patients younger than 17 years admitted to an intensive care unit with blunt traumatic brain injury (TBI), Injury Severity Score (ISS) greater than 9, and Glasgow Coma Scale (GCS) score less than 9. Patients with incomplete medical records and those with intensive care unit length of stay of less than 24 hours were excluded from the study. MAIN OUTCOMES AND MEASURES Parametric comparisons (t tests and χ2 as appropriate) were performed to compare patients who received ICP monitoring with those who did not. Stepwise logistic regression methods were used to assess whether ICP monitoring in the presence of other variables (age, sex, ISS, Revised Trauma Score, and GCS score) was associated with survival. RESULTS Monitoring of ICP was performed in only 7.7% of patients who met the monitoring criteria recommended by the Brain Trauma Foundation. There were no significant differences in age, sex, or GCS score. After adjustment for admission GCS score, age group, sex, Revised Trauma Score, and injury ISS, ICP monitoring was associated with a reduction in mortality only for patients with a GCS score of 3 (odds ratio, 0.64; 95% CI, 0.43-1.00). Comparison between the 2 groups showed that the ICP monitoring group had a longer hospital length of stay (21.0 days vs 10.4 days; P