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

作者：Van Cleve William; Kernic Mary A; Ellenbogen Richard G; Wang Jin; Zatzick Douglas F; Bell Michael J; Wainwright Mark S; Groner Jonathan I; Mink Richard B; Giza Christopher C; Boyle Linda Ng; Mitchell Pamela H; Rivara Frederick P; Vavilala Monica S^*

来源：Neurosurgery, 2013, 73(5): 746-752.

DOI：10.1227/NEU.0000000000000097

• Decompressive craniectomy
• Intracranial pressure monitoring

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 with the use of data submitted to the American College of Surgeons National Trauma Databank.
RESULTS: We analyzed data from 7140 children at 156 US hospitals during 7 continuous years. Of the children, 27.4% had ICPM, whereas 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 among children treated at adult-only trauma centers (relative risk = 0.80; 95% confidence interval 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 toward 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.

• 出版日期2013-11
• 单位西北大学