Osmolar therapy in pediatric traumatic brain injury
To describe patterns of use for mannitol and hypertonic saline in children with traumatic brain injury, to evaluate any potential associations between hypertonic saline and mannitol use and patient demographic, injury, and treatment hospital characteristics, and to determine whether the 2003 guideli...
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| Veröffentlicht in: | Critical care medicine 2012, Vol.40 (1), p.208-215 |
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| creator | BENNETT, Tellen D STATLER, Kimberly D KENT KORGENSKI, E BRATTON, Susan L |
| description | To describe patterns of use for mannitol and hypertonic saline in children with traumatic brain injury, to evaluate any potential associations between hypertonic saline and mannitol use and patient demographic, injury, and treatment hospital characteristics, and to determine whether the 2003 guidelines for severe pediatric traumatic brain injury impacted clinical practice regarding osmolar therapy.
Retrospective cohort study.
Pediatric Health Information System database, January, 2001 to December, 2008.
Children (age |
| doi_str_mv | 10.1097/CCM.0b013e31822e9d31 |
| format | Article |
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Retrospective cohort study.
Pediatric Health Information System database, January, 2001 to December, 2008.
Children (age <18 yrs) with traumatic brain injury and head/neck Abbreviated Injury Scale score ≥ 3 who received mechanical ventilation and intensive care.
: None.
The primary outcome was hospital billing for parenteral hypertonic saline and mannitol use, by day of service. Overall, 33% (2,069 of 6,238) of the patients received hypertonic saline, and 40% (2,500 of 6,238) received mannitol. Of the 1,854 patients who received hypertonic saline or mannitol for ≥ 2 days in the first week of therapy, 29% did not have intracranial pressure monitoring. After adjustment for hospital-level variation, primary insurance payer, and overall injury severity, use of both drugs was independently associated with older patient age, intracranial hemorrhage (other than epidural), skull fracture, and higher head/neck injury severity. Hypertonic saline use increased and mannitol use decreased with publication of the 2003 guidelines, and these trends continued through 2008.
Hypertonic saline and mannitol are used less in infants than in older children. The patient-level and hospital-level variation in osmolar therapy use and the substantial amount of sustained osmolar therapy without intracranial pressure monitoring suggest opportunities to improve the quality of pediatric traumatic brain injury care. With limited high-quality evidence available, published expert guidelines appear to significantly impact clinical practice in this area.</description><identifier>ISSN: 0090-3493</identifier><identifier>EISSN: 1530-0293</identifier><identifier>DOI: 10.1097/CCM.0b013e31822e9d31</identifier><identifier>PMID: 21926592</identifier><identifier>CODEN: CCMDC7</identifier><language>eng</language><publisher>Hagerstown, MD: Lippincott Williams & Wilkins</publisher><subject>Adolescent ; Age Factors ; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Biological and medical sciences ; Brain Injuries - drug therapy ; Brain Injuries - therapy ; Child ; Child, Preschool ; Emergency and intensive care: neonates and children. Prematurity. Sudden death ; Female ; Fluid Therapy - methods ; Humans ; Infant ; Infant, Newborn ; Injury Severity Score ; Intensive care medicine ; Intracranial Pressure - drug effects ; Male ; Mannitol - administration & dosage ; Mannitol - therapeutic use ; Medical sciences ; Retrospective Studies ; Saline Solution, Hypertonic - therapeutic use ; Treatment Outcome</subject><ispartof>Critical care medicine, 2012, Vol.40 (1), p.208-215</ispartof><rights>2015 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c437t-f94d8d19243a2af11932a78312d0803b367403de587dcb0f13de770557c176f23</citedby><cites>FETCH-LOGICAL-c437t-f94d8d19243a2af11932a78312d0803b367403de587dcb0f13de770557c176f23</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,885,4024,27923,27924,27925</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=25498739$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21926592$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>BENNETT, Tellen D</creatorcontrib><creatorcontrib>STATLER, Kimberly D</creatorcontrib><creatorcontrib>KENT KORGENSKI, E</creatorcontrib><creatorcontrib>BRATTON, Susan L</creatorcontrib><title>Osmolar therapy in pediatric traumatic brain injury</title><title>Critical care medicine</title><addtitle>Crit Care Med</addtitle><description>To describe patterns of use for mannitol and hypertonic saline in children with traumatic brain injury, to evaluate any potential associations between hypertonic saline and mannitol use and patient demographic, injury, and treatment hospital characteristics, and to determine whether the 2003 guidelines for severe pediatric traumatic brain injury impacted clinical practice regarding osmolar therapy.
Retrospective cohort study.
Pediatric Health Information System database, January, 2001 to December, 2008.
Children (age <18 yrs) with traumatic brain injury and head/neck Abbreviated Injury Scale score ≥ 3 who received mechanical ventilation and intensive care.
: None.
The primary outcome was hospital billing for parenteral hypertonic saline and mannitol use, by day of service. Overall, 33% (2,069 of 6,238) of the patients received hypertonic saline, and 40% (2,500 of 6,238) received mannitol. Of the 1,854 patients who received hypertonic saline or mannitol for ≥ 2 days in the first week of therapy, 29% did not have intracranial pressure monitoring. After adjustment for hospital-level variation, primary insurance payer, and overall injury severity, use of both drugs was independently associated with older patient age, intracranial hemorrhage (other than epidural), skull fracture, and higher head/neck injury severity. Hypertonic saline use increased and mannitol use decreased with publication of the 2003 guidelines, and these trends continued through 2008.
Hypertonic saline and mannitol are used less in infants than in older children. The patient-level and hospital-level variation in osmolar therapy use and the substantial amount of sustained osmolar therapy without intracranial pressure monitoring suggest opportunities to improve the quality of pediatric traumatic brain injury care. With limited high-quality evidence available, published expert guidelines appear to significantly impact clinical practice in this area.</description><subject>Adolescent</subject><subject>Age Factors</subject><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Biological and medical sciences</subject><subject>Brain Injuries - drug therapy</subject><subject>Brain Injuries - therapy</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Emergency and intensive care: neonates and children. Prematurity. Sudden death</subject><subject>Female</subject><subject>Fluid Therapy - methods</subject><subject>Humans</subject><subject>Infant</subject><subject>Infant, Newborn</subject><subject>Injury Severity Score</subject><subject>Intensive care medicine</subject><subject>Intracranial Pressure - drug effects</subject><subject>Male</subject><subject>Mannitol - administration & dosage</subject><subject>Mannitol - therapeutic use</subject><subject>Medical sciences</subject><subject>Retrospective Studies</subject><subject>Saline Solution, Hypertonic - therapeutic use</subject><subject>Treatment Outcome</subject><issn>0090-3493</issn><issn>1530-0293</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkElLBDEQhYMoOi7_QGQu4qm1KpWedC6CDG6geNFzSKfTGullTLqF-fdGZlxP9aC-eq94jB0inCIoeTaf359CCUiOsODcqYpwg00wJ8iAK9pkEwAFGQlFO2w3xlcAFLmkbbbDUfFZrviE0UNs-8aE6fDiglksp76bLlzlzRC8nQ7BjK0ZkiqDSRvfvY5huc-2atNEd7Cee-zp6vJxfpPdPVzfzi_uMitIDlmtRFVUKUmQ4aZGVMSNLAh5BQVQSTMpgCqXF7KyJdSYtJSQ59KinNWc9tj5yncxlq2rrOvSP41eBN-asNS98frvpvMv-rl_18QFV5Ang5O1QejfRhcH3fpoXdOYzvVj1Ao5giQUiRQr0oY-xuDq7xQE_Vm3TnXr_3Wns6PfH34fffWbgOM1YKI1TR1MZ3384XKhCkmKPgBKKIj4</recordid><startdate>2012</startdate><enddate>2012</enddate><creator>BENNETT, Tellen D</creator><creator>STATLER, Kimberly D</creator><creator>KENT KORGENSKI, E</creator><creator>BRATTON, Susan L</creator><general>Lippincott Williams & Wilkins</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>2012</creationdate><title>Osmolar therapy in pediatric traumatic brain injury</title><author>BENNETT, Tellen D ; STATLER, Kimberly D ; KENT KORGENSKI, E ; BRATTON, Susan L</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c437t-f94d8d19243a2af11932a78312d0803b367403de587dcb0f13de770557c176f23</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Adolescent</topic><topic>Age Factors</topic><topic>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>Biological and medical sciences</topic><topic>Brain Injuries - drug therapy</topic><topic>Brain Injuries - therapy</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Emergency and intensive care: neonates and children. Prematurity. Sudden death</topic><topic>Female</topic><topic>Fluid Therapy - methods</topic><topic>Humans</topic><topic>Infant</topic><topic>Infant, Newborn</topic><topic>Injury Severity Score</topic><topic>Intensive care medicine</topic><topic>Intracranial Pressure - drug effects</topic><topic>Male</topic><topic>Mannitol - administration & dosage</topic><topic>Mannitol - therapeutic use</topic><topic>Medical sciences</topic><topic>Retrospective Studies</topic><topic>Saline Solution, Hypertonic - therapeutic use</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>BENNETT, Tellen D</creatorcontrib><creatorcontrib>STATLER, Kimberly D</creatorcontrib><creatorcontrib>KENT KORGENSKI, E</creatorcontrib><creatorcontrib>BRATTON, Susan L</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Critical care medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>BENNETT, Tellen D</au><au>STATLER, Kimberly D</au><au>KENT KORGENSKI, E</au><au>BRATTON, Susan L</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Osmolar therapy in pediatric traumatic brain injury</atitle><jtitle>Critical care medicine</jtitle><addtitle>Crit Care Med</addtitle><date>2012</date><risdate>2012</risdate><volume>40</volume><issue>1</issue><spage>208</spage><epage>215</epage><pages>208-215</pages><issn>0090-3493</issn><eissn>1530-0293</eissn><coden>CCMDC7</coden><abstract>To describe patterns of use for mannitol and hypertonic saline in children with traumatic brain injury, to evaluate any potential associations between hypertonic saline and mannitol use and patient demographic, injury, and treatment hospital characteristics, and to determine whether the 2003 guidelines for severe pediatric traumatic brain injury impacted clinical practice regarding osmolar therapy.
Retrospective cohort study.
Pediatric Health Information System database, January, 2001 to December, 2008.
Children (age <18 yrs) with traumatic brain injury and head/neck Abbreviated Injury Scale score ≥ 3 who received mechanical ventilation and intensive care.
: None.
The primary outcome was hospital billing for parenteral hypertonic saline and mannitol use, by day of service. Overall, 33% (2,069 of 6,238) of the patients received hypertonic saline, and 40% (2,500 of 6,238) received mannitol. Of the 1,854 patients who received hypertonic saline or mannitol for ≥ 2 days in the first week of therapy, 29% did not have intracranial pressure monitoring. After adjustment for hospital-level variation, primary insurance payer, and overall injury severity, use of both drugs was independently associated with older patient age, intracranial hemorrhage (other than epidural), skull fracture, and higher head/neck injury severity. Hypertonic saline use increased and mannitol use decreased with publication of the 2003 guidelines, and these trends continued through 2008.
Hypertonic saline and mannitol are used less in infants than in older children. The patient-level and hospital-level variation in osmolar therapy use and the substantial amount of sustained osmolar therapy without intracranial pressure monitoring suggest opportunities to improve the quality of pediatric traumatic brain injury care. With limited high-quality evidence available, published expert guidelines appear to significantly impact clinical practice in this area.</abstract><cop>Hagerstown, MD</cop><pub>Lippincott Williams & Wilkins</pub><pmid>21926592</pmid><doi>10.1097/CCM.0b013e31822e9d31</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Critical care medicine, 2012, Vol.40 (1), p.208-215 |
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| subjects | Adolescent Age Factors Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Biological and medical sciences Brain Injuries - drug therapy Brain Injuries - therapy Child Child, Preschool Emergency and intensive care: neonates and children. Prematurity. Sudden death Female Fluid Therapy - methods Humans Infant Infant, Newborn Injury Severity Score Intensive care medicine Intracranial Pressure - drug effects Male Mannitol - administration & dosage Mannitol - therapeutic use Medical sciences Retrospective Studies Saline Solution, Hypertonic - therapeutic use Treatment Outcome |
| title | Osmolar therapy in pediatric traumatic brain injury |
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