Association Between Intracranial Pressure Monitoring and Discharge Outcome in Pediatric Severe Traumatic Brain Injury.

IF 4.9 2区医学 Q1 CRITICAL CARE MEDICINE

Pediatric Critical Care Medicine Pub Date : 2026-10-01 Epub Date: 2026-08-19 DOI:10.1097/PCC.0000000000004030

Caitlin R McNamara, Kelsey A Johnson-Nibling, Michael T Bigham, Dennis W Simon, Alicia K Au, Michael Forbes, Christopher M Horvat, Patrick M Kochanek, Christopher K Page-Goertz, Jonathan H Pelletier

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引用次数: 0

Abstract

Objective: To determine whether intracranial pressure (ICP) monitoring is associated with decreased mortality among pediatric severe traumatic brain injury (TBI) patients.

Design: Retrospective cohort study of the Virtual Pediatric Systems database.

Patients: Patients younger than 18 years with diagnosis codes for TBI and Glasgow Coma Scale (GCS) of less than or equal to 8 between 2010 and 2024 from centers submitting ICP monitor data.

Measurements: ICP monitoring practices were described using summary statistics. To estimate time-dependent association between ICP monitor placement and 30-day mortality, time-varying Cox proportional hazards modeling was performed. In a second complementary analysis to minimize immortal time bias, landmarked unadjusted Kaplan-Meier analyses and adjusted Cox proportional hazards models of ICP monitor placement by 1, 12, and 24 hours were performed.

Main results: There were 6636 admissions included across 94 PICUs between January 1, 2010, and December 31, 2024; 2016 of 6636 (30.7%) had ICP monitors. Patients with ICP monitors were older (8 yr [3-14] vs. 6 yr [2-13], p < 0.001), had lower GCS (3 [3-6] vs. 6 [3-7], p < 0.001), and a higher Pediatric Risk of Mortality 3 score (12.0 [8.0-21.0] vs. 9.0 [5.0-21.0], p < 0.001). ICP monitor placement was associated with lower time-specific mortality hazard until 4.4 d (95% CI, 3.7-5.2) in unadjusted and 10.5 d (95% CI, 7.2-30.0) in adjusted time-varying Cox modeling, resulting in lower 30-day cumulative mortality in the adjusted model only (29.2% [95% CI, 28.0-30.6%]) in the unmonitored group vs. (25.1% [95% CI, 23.4-26.5%]) in the monitored group. In landmark analysis and adjustment for severity, ICP monitor placement was associated with a significantly lower 30-day-mortality hazard ratio (HR) at the 1-hour (adjusted HR 0.81 [0.69, 0.94]), 12-hr (0.83 [0.73, 0.95]), and 24-hr landmarks (0.80 [0.69, 0.92]).

Conclusions: ICP monitoring was associated with reduced mortality for 10 days after admission, followed by increased mortality between days 11 and 30. The stronger effect of reduced early mortality resulted in lower 30-day cumulative mortality.

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颅内压监测与儿童重型颅脑损伤出院预后的关系。

目的：确定颅内压（ICP）监测是否与儿童严重创伤性脑损伤（TBI）患者死亡率降低相关。设计：虚拟儿科系统数据库的回顾性队列研究。患者：年龄小于18岁，2010年至2024年间TBI诊断代码和格拉斯哥昏迷评分（GCS）小于或等于8的患者，来自提交ICP监测数据的中心。测量：使用汇总统计描述ICP监测实践。为了估计ICP监测仪放置与30天死亡率之间的时间依赖性关联，进行了时变Cox比例风险建模。在第二个补充分析中，为了最大限度地减少不朽时间偏差，对ICP监护仪放置1、12和24小时进行了具有里程碑意义的未调整Kaplan-Meier分析和调整的Cox比例风险模型。主要结果：2010年1月1日至2024年12月31日，94个picu共入院6636例；6636例（30.7%）中2016年有ICP监测仪。使用ICP监护仪的患者年龄较大（8岁[3-14]对6岁[2-13]，p < 0.001）， GCS较低（3[3-6]对6 [3-7]，p < 0.001），儿科死亡风险3评分较高（12.0[8.0-21.0]对9.0 [5.0-21.0],p < 0.001）。在未调整的4.4 d （95% CI, 3.7-5.2）和调整时变Cox模型的10.5 d （95% CI, 7.2-30.0）之前，ICP监测仪放置与较低的时间特异性死亡率相关，仅在调整模型中，未监测组的30天累积死亡率较低（29.2% [95% CI, 28.0-30.6%]），而监测组的30天累积死亡率较低（25.1% [95% CI, 23.4-26.5%]）。在里程碑分析和严重程度调整中，ICP监测仪放置与1小时（调整后的HR 0.81[0.69, 0.94]）、12小时（0.83[0.73,0.95]）和24小时里程碑（0.80[0.69,0.92]）的30天死亡率风险比（HR）显著降低相关。结论：ICP监测与入院后10天死亡率降低相关，随后在第11天至第30天死亡率增加。降低早期死亡率的效果更强，导致30天累积死亡率降低。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Pediatric Critical Care Medicine 医学-危重病医学

CiteScore

7.40

自引率

14.60%

发文量

991

审稿时长

3-8 weeks

期刊介绍： Pediatric Critical Care Medicine is written for the entire critical care team: pediatricians, neonatologists, respiratory therapists, nurses, and others who deal with pediatric patients who are critically ill or injured. International in scope, with editorial board members and contributors from around the world, the Journal includes a full range of scientific content, including clinical articles, scientific investigations, solicited reviews, and abstracts from pediatric critical care meetings. Additionally, the Journal includes abstracts of selected articles published in Chinese, French, Italian, Japanese, Portuguese, and Spanish translations - making news of advances in the field available to pediatric and neonatal intensive care practitioners worldwide.