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

Abstract 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.

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Journal
Intensive Care Medicine – Paediatric and Neonatal
Published
2025-10-21
DOI
https://doi.org/10.1007/s44253-025-00102-4
Primary Topic
Traumatic Brain Injury and Neurovascular Disturbances
Type
article
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article

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

Jesús Domínguez-Rojas, Hiroshi Kurosawa, Shu‐Ling Chong, Juan Camilo Jaramillo Bustamante et al.
Intensive Care Medicine – Paediatric and Neonatal
Traumatic Brain Injury and Neurovascular Disturbances
article

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

Jesús Domínguez-Rojas, Hiroshi Kurosawa, Shu‐Ling Chong, Juan Camilo Jaramillo Bustamante, Sebastián González‐Dambrauskas, María Miñambres Rodríguez, Chin Seng Gan, Jan Hau Lee, Natalia Elizabeth Gómez Arriola, Iván Gómez, Freddy Israel Pantoja Chamorro, Hongxing Dang, Suyun Qian, Paula Caporal, Nattachai Anantasit, Yasser Kazzaz, Juan D. Roa G, Rubén Eduardo Lasso Palomino, Syeda Kashfi Qadri, Adriana Yock‐Corrales, Deborah M. Turina, Meixiu Ming, Thelma Elvira Terán Miranda, Natalia Zita Watzlawik, Tao Zhang, Jacqueline Soo May Ong, Gabriela Aparicio, G. Shen, Qalab Abbas, P. Ng, Rujipat Samransamruajkit
article en

Abstract

Abstract 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.

Intensive Care Medicine – Paediatric and NeonatalVol. 3(1)
Johns Hopkins University (US), SingHealth (SG), Universidad de la República de Uruguay (UY), King Saud bin Abdulaziz University for Health Sciences (SA), Universidad El Bosque (CO), Centro Hospitalario Pereira Rossell (UY), Aga Khan University Hospital (PK), King Abdullah International Medical Research Center (SA), SingHealth Duke-NUS Academic Medical Centre (SG), KK Women's and Children's Hospital (SG), RedCLARA (UY), Duke-NUS Medical School (SG), Hospital Nacional de Niños (CR), National Institute of Child Health (PK), MOH Holdings (SG), National Guard Health Affairs (SA)
Duke-NUS Medical School
Openalex Percentile: Top 57%
Traumatic Brain Injury and Neurovascular Disturbances
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