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Background <p>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.</p> Methods <p>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 &lt; 18&#xa0;years old with sTBI (Glasgow Coma Scale ≤ 8) who presented within 24&#xa0;h of injury and survived beyond 24&#xa0;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.</p> Results <p>Among 431 patients, 104 (24.1%) received invasive ICP monitoring. Patients with monitoring were more likely to receive critical care interventions within 24&#xa0;h of admission, including intubation (98.1% vs. 87.1%, <i>p</i> = 0.001), prophylactic anti-epileptics (75.0% vs. 64.5%, <i>p</i> = 0.048), and decompressive craniectomy (30.2% vs. 10.5%, <i>p</i> &lt; 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, <i>p</i> = 0.045).</p> Conclusions <p>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.</p>

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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

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  • 发表日期：

    2025年10月21日

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  • 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,
  • 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

摘要

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.