National Variability in Intracranial Pressure Monitoring and Craniotomy for Children with Moderate to Severe Traumatic Brain Injury

Authors: Van Cleve W, Kernic MA, Ellenbogen RG, Wang J, Zatzick DF, Bell MJ, Wainwright MS, Groner JI, Mink RB, Giza CC, Boyle LN, Mitchell PH, Rivara FP, Vavilala MS; for the PEGASUS (Pediatric Guideline Adherence and Outcomes) Project.

BACKGROUND: Traumatic brain injury (TBI) is a significant cause of mortality and disability in children. Intracranial pressure monitoring (ICPM) and craniotomy/craniectomy (CRANI) may affect outcomes. Sources of variability in the use of these interventions remain incompletely understood.

OBJECTIVE: To analyze sources of variability in the use of ICPM and CRANI.

METHODS: Retrospective cross-sectional study of patients with moderate/severe pediatric TBI using data submitted to the American College of Surgeons National Trauma Databank.

RESULTS: We analyzed data from 7,140 children at 156 US hospitals during 7 continuous years. 27.4% of children had ICPM, while 11.7% had a CRANI. Infants had lower rates of ICPM and CRANI than older children. A lower rate of ICPM was observed among children hospitalized at combined pediatric/adult trauma centers than children treated at adult-only trauma centers (RR 0.80, 95% CI 0.66 - 0.97). For ICPM and CRANI, 18.5% and 11.6%, respectively, of residual model variance was explained by between-hospital variation in care delivery, but almost no correlation was observed between within-hospital tendency towards performing these procedures.

CONCLUSION: Infants received less ICPM than older children, and children hospitalized at pediatric trauma centers received less ICPM than children at adult-only trauma centers. In addition, significant between-hospital variability existed in the delivery of ICPM and CRANI to children with moderate-severe TBI.

Full text and source: Neurosurgery

Neurosurgery. 2013 Jul 16.