Sekar Arunkumar1, Bhagavatula Indira Devi1, Dhaval Shukla1, Madhusudhan Reddy2. 1. Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India. 2. Department of Neuroanesthesiology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India.
Abstract
BACKGROUND: Intracranial pressure monitoring (ICP) is considered as optional for management of severe traumatic brain injury (TBI) in children. AIMS: This study was performed to determine whether ICP monitoring is beneficial in the managing severe TBI in children. SETTINGS AND DESIGN: Neurosurgical intensive care unit (ICU) of a tertiary care referral center; prospective observational study. MATERIALS AND METHODS: Children aged 16 years or less with severe TBI defined as "postresuscitation Glasgow Coma Scale (GCS) score of 8 or less admitted to an ICU" were enrolled. All children underwent standard treatment for TBI as indicated. ICP monitoring was done in 30 cases and was not done in 20 cases. The outcome in both the groups was assessed using Glasgow outcome scale. STATISTICAL ANALYSIS: The characteristics of the patients in the two groups were compared using independent sample T test for continuous variables and chi-square and Mann-Whitney test for nonparametric variables. RESULTS: The children who did not undergo ICP monitoring required more number of doses of hyperosmolar agents. However, the duration of ventilation and length of ICU stay were significantly shorter in children who did not undergo ICP monitoring. The outcome was unfavorable in 16.7% of children who underwent ICP monitoring as compared with 55% of children who did not undergo ICP monitoring; this difference was significant. CONCLUSIONS: ICP-targeted therapy results in significantly better outcome in children with severe TBI.
BACKGROUND: Intracranial pressure monitoring (ICP) is considered as optional for management of severe traumatic brain injury (TBI) in children. AIMS: This study was performed to determine whether ICP monitoring is beneficial in the managing severe TBI in children. SETTINGS AND DESIGN: Neurosurgical intensive care unit (ICU) of a tertiary care referral center; prospective observational study. MATERIALS AND METHODS:Children aged 16 years or less with severe TBI defined as "postresuscitation Glasgow Coma Scale (GCS) score of 8 or less admitted to an ICU" were enrolled. All children underwent standard treatment for TBI as indicated. ICP monitoring was done in 30 cases and was not done in 20 cases. The outcome in both the groups was assessed using Glasgow outcome scale. STATISTICAL ANALYSIS: The characteristics of the patients in the two groups were compared using independent sample T test for continuous variables and chi-square and Mann-Whitney test for nonparametric variables. RESULTS: The children who did not undergo ICP monitoring required more number of doses of hyperosmolar agents. However, the duration of ventilation and length of ICU stay were significantly shorter in children who did not undergo ICP monitoring. The outcome was unfavorable in 16.7% of children who underwent ICP monitoring as compared with 55% of children who did not undergo ICP monitoring; this difference was significant. CONCLUSIONS: ICP-targeted therapy results in significantly better outcome in children with severe TBI.
Authors: Patrick T Delaplain; Areg Grigorian; Michael Lekawa; Michael Mallicote; Victor Joe; Sebastian D Schubl; Catherine M Kuza; Matthew Dolich; Jeffry Nahmias Journal: Pediatr Surg Int Date: 2020-01-14 Impact factor: 1.827