Intra-cranial pressure monitoring is associated with lower in-hospital mortality but not with improved functional outcomes in pediatric traumatic brain injury: a multicenter observational study
Year: 2025
Type: article
Abstract: Background Evidence that the use of invasive intracranial pressure (ICP) monitoring improves outcomes in severe traumatic brain injury (sTBI) remains equivocal. We investigated the association between invasive ICP monitoring and mortality, as well as functional outcomes, among children with sTBI. Methods We performed a secondary analysis of a multicenter TBI cohort with patients admitted to 23 intensive care units across Asia and Latin America between January 2014 and December 2022. We analyzed patients < 18 years old with sTBI (Glasgow Coma Scale ≤ 8) who presented within 24 h of injury and survived beyond 24 h of admission. We compared characteristics and outcomes between patients with and without invasive ICP monitoring. We performed multivariable logistic regression to identify factors associated with in-hospital mortality, poor discharge Pediatric Cerebral Performance Category, and poor 3-months post-discharge Glasgow Outcome Scale-Extended Pediatrics Revision. Results Among 431 patients, 104 (24.1%) received invasive ICP monitoring. Patients with monitoring were more likely to receive critical care interventions within 24 h of admission, including intubation (98.1% vs. 87.1%, p = 0.001), prophylactic anti-epileptics (75.0% vs. 64.5%, p = 0.048), and decompressive craniectomy (30.2% vs. 10.5%, p < 0.001). After adjusting for age, sex, admission GCS, multiple trauma, and subarachnoid hemorrhage, ICP monitoring was associated with reduced mortality (adjusted odds ratio 0.26, 95% confidence interval 0.07–0.97, p = 0.045). Conclusions In pediatric sTBI, ICP monitoring was associated with reduced in-hospital mortality but not with improved functional outcomes. Future studies should investigate how ICP monitoring affects management for raised ICP and how these managements affect clinical outcome.
Authors: Gawin Shen, Syeda Kashfi Qadri, Jesús A. Domínguez-Rojas, Shu-Ling Chong, Paula Caporal, Juan D. Roa G, Sebastián González-Dambrauskas, Adriana Yock-Corrales, Qalab Abbas, Yasser Kazzaz, Pei Wen Ng, Jan Hau Lee, Pediatric Acute & Critical Care Medicine Asian Network (PACCMAN) and Pediatric Collaborative Latin American Network (LARed Network), Chin Seng Gan, Rujipat Samransamruajkit, Tao Zhang, Meixiu Ming, Hongxing Dang, Hiroshi Kurosawa, Suyun Qian, Jacqueline Ong, Nattachai Anantasit, Deborah M. Turina, Ivan Jose Ardila Gomez, Gabriela Aparicio, Juan Camilo Jaramillo Bustamante, Thelma Elvira Teran Miranda, María Miñambres Rodríguez, Freddy Israel Pantoja Chamorro, Natalia Elizabeth Gómez Arriola, Rubén Eduardo Lasso Palomino, Natalia Zita Watzlawik
Institutions: Duke-NUS Medical School, MOH Holdings, SingHealth, SingHealth Duke-NUS Academic Medical Centre, KK Women's and Children's Hospital, National University of Singapore, Johns Hopkins University, Universidad El Bosque, Universidad de la República de Uruguay, Centro Hospitalario Pereira Rossell, Aga Khan University Hospital, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, King Abdullah International Medical Research Center, National Guard Health Affairs
Language: English
Subfield: Neurology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $2,090
Funders: Duke-NUS Medical School, SingHealth
Award: G4759570557
OpenAlex ID: W4415382032