Current practice of intracranial pressure monitoring in children with severe traumatic brain injury—a nationwide prospective surveillance study in Germany
BackgroundFor management of severe traumatic brain injuries (sTBI) in children, the overall level of evidence to guide diagnostic and therapeutic procedures is low. Since 2016, international guidelines have subsequently suggested invasive intracranial pressure (ICP) monitoring in patients with initi...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2024-02-01
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| Series: | Frontiers in Pediatrics |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fped.2024.1355771/full |
| _version_ | 1827355185787174912 |
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| author | Pia Brensing Pia Brensing Sandra Greve Sandra Greve Rayan Hojeij Rayan Hojeij Philipp Dammann Philipp Dammann Ursula Felderhoff-Müser Ursula Felderhoff-Müser Christian Dohna-Schwake Christian Dohna-Schwake Nora Bruns Nora Bruns |
| author_facet | Pia Brensing Pia Brensing Sandra Greve Sandra Greve Rayan Hojeij Rayan Hojeij Philipp Dammann Philipp Dammann Ursula Felderhoff-Müser Ursula Felderhoff-Müser Christian Dohna-Schwake Christian Dohna-Schwake Nora Bruns Nora Bruns |
| author_sort | Pia Brensing |
| collection | DOAJ |
| description | BackgroundFor management of severe traumatic brain injuries (sTBI) in children, the overall level of evidence to guide diagnostic and therapeutic procedures is low. Since 2016, international guidelines have subsequently suggested invasive intracranial pressure (ICP) monitoring in patients with initial Glasgow Coma Scale (GCS) ≤8. In Germany, ICP monitoring was an individual case decision from 2011 until the 2022 update of the German pediatric TBI guideline. The aim of this study was to evaluate current clinical practice of invasive ICP monitoring in Germany in children <10 years with respect to guideline recommendations.MethodsAnonymized clinical data on sTBI cases <10 years of age were collected in a nationwide prospective surveillance study via the German Pediatric Surveillance Unit ESPED from July 2019 until June 2022. Inclusion criteria for the surveillance study were sTBI (initial GCS ≤8) or neurosurgery following TBI. For this analysis, only cases with GCS ≤8 were subject to the present analysis. Descriptive analyses were performed to assess the proportion of ICP monitored patients and describe the cohort.ResultsOut of 217 reported cases, 102 cases met the inclusion criteria and thus qualified for ICP monitoring. Of these, 37 (36%) received ICP monitoring. Monitored patients were older, had lower median GCS values at presentation (4 vs. 5), higher mortality (32% vs. 22%), and were more frequently diagnosed with cerebral edema (68% vs. 37%).ConclusionIn children <10 years with sTBI, the present clinical management regarding ICP monitoring deviates from the current German national and international guidelines. The reasons remain unclear, with the low level of evidence in the field of ICP monitoring and the recency of changes in guideline recommendations as potential contributors. Prospective interventional studies should elucidate the benefit of ICP monitoring and ICP directed therapies to provide evidence-based recommendations on ICP monitoring. |
| first_indexed | 2024-03-08T04:06:57Z |
| format | Article |
| id | doaj.art-cdb80a9e87c6411ab3311e036ac87d09 |
| institution | Directory Open Access Journal |
| issn | 2296-2360 |
| language | English |
| last_indexed | 2024-03-08T04:06:57Z |
| publishDate | 2024-02-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Pediatrics |
| spelling | doaj.art-cdb80a9e87c6411ab3311e036ac87d092024-02-09T05:00:45ZengFrontiers Media S.A.Frontiers in Pediatrics2296-23602024-02-011210.3389/fped.2024.13557711355771Current practice of intracranial pressure monitoring in children with severe traumatic brain injury—a nationwide prospective surveillance study in GermanyPia Brensing0Pia Brensing1Sandra Greve2Sandra Greve3Rayan Hojeij4Rayan Hojeij5Philipp Dammann6Philipp Dammann7Ursula Felderhoff-Müser8Ursula Felderhoff-Müser9Christian Dohna-Schwake10Christian Dohna-Schwake11Nora Bruns12Nora Bruns13Department of Pediatrics I, Neonatology, Pediatric Intensive Care Medicine, and Pediatric Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, GermanyC-TNBS, Centre for Translational Neuro- and Behavioral Sciences, University Hospital Essen, University of Duisburg-Essen, Essen, GermanyDepartment of Pediatrics I, Neonatology, Pediatric Intensive Care Medicine, and Pediatric Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, GermanyC-TNBS, Centre for Translational Neuro- and Behavioral Sciences, University Hospital Essen, University of Duisburg-Essen, Essen, GermanyDepartment of Pediatrics I, Neonatology, Pediatric Intensive Care Medicine, and Pediatric Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, GermanyC-TNBS, Centre for Translational Neuro- and Behavioral Sciences, University Hospital Essen, University of Duisburg-Essen, Essen, GermanyC-TNBS, Centre for Translational Neuro- and Behavioral Sciences, University Hospital Essen, University of Duisburg-Essen, Essen, GermanyDepartment of Neurosurgery and Spine Surgery, University Hospital Essen, University of Duisburg-Essen, Essen, GermanyDepartment of Pediatrics I, Neonatology, Pediatric Intensive Care Medicine, and Pediatric Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, GermanyC-TNBS, Centre for Translational Neuro- and Behavioral Sciences, University Hospital Essen, University of Duisburg-Essen, Essen, GermanyDepartment of Pediatrics I, Neonatology, Pediatric Intensive Care Medicine, and Pediatric Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, GermanyC-TNBS, Centre for Translational Neuro- and Behavioral Sciences, University Hospital Essen, University of Duisburg-Essen, Essen, GermanyDepartment of Pediatrics I, Neonatology, Pediatric Intensive Care Medicine, and Pediatric Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, GermanyC-TNBS, Centre for Translational Neuro- and Behavioral Sciences, University Hospital Essen, University of Duisburg-Essen, Essen, GermanyBackgroundFor management of severe traumatic brain injuries (sTBI) in children, the overall level of evidence to guide diagnostic and therapeutic procedures is low. Since 2016, international guidelines have subsequently suggested invasive intracranial pressure (ICP) monitoring in patients with initial Glasgow Coma Scale (GCS) ≤8. In Germany, ICP monitoring was an individual case decision from 2011 until the 2022 update of the German pediatric TBI guideline. The aim of this study was to evaluate current clinical practice of invasive ICP monitoring in Germany in children <10 years with respect to guideline recommendations.MethodsAnonymized clinical data on sTBI cases <10 years of age were collected in a nationwide prospective surveillance study via the German Pediatric Surveillance Unit ESPED from July 2019 until June 2022. Inclusion criteria for the surveillance study were sTBI (initial GCS ≤8) or neurosurgery following TBI. For this analysis, only cases with GCS ≤8 were subject to the present analysis. Descriptive analyses were performed to assess the proportion of ICP monitored patients and describe the cohort.ResultsOut of 217 reported cases, 102 cases met the inclusion criteria and thus qualified for ICP monitoring. Of these, 37 (36%) received ICP monitoring. Monitored patients were older, had lower median GCS values at presentation (4 vs. 5), higher mortality (32% vs. 22%), and were more frequently diagnosed with cerebral edema (68% vs. 37%).ConclusionIn children <10 years with sTBI, the present clinical management regarding ICP monitoring deviates from the current German national and international guidelines. The reasons remain unclear, with the low level of evidence in the field of ICP monitoring and the recency of changes in guideline recommendations as potential contributors. Prospective interventional studies should elucidate the benefit of ICP monitoring and ICP directed therapies to provide evidence-based recommendations on ICP monitoring.https://www.frontiersin.org/articles/10.3389/fped.2024.1355771/fullchildrensevere traumatic brain injuryintracranial pressure monitoringoutcomesICPneuromonitoring |
| spellingShingle | Pia Brensing Pia Brensing Sandra Greve Sandra Greve Rayan Hojeij Rayan Hojeij Philipp Dammann Philipp Dammann Ursula Felderhoff-Müser Ursula Felderhoff-Müser Christian Dohna-Schwake Christian Dohna-Schwake Nora Bruns Nora Bruns Current practice of intracranial pressure monitoring in children with severe traumatic brain injury—a nationwide prospective surveillance study in Germany Frontiers in Pediatrics children severe traumatic brain injury intracranial pressure monitoring outcomes ICP neuromonitoring |
| title | Current practice of intracranial pressure monitoring in children with severe traumatic brain injury—a nationwide prospective surveillance study in Germany |
| title_full | Current practice of intracranial pressure monitoring in children with severe traumatic brain injury—a nationwide prospective surveillance study in Germany |
| title_fullStr | Current practice of intracranial pressure monitoring in children with severe traumatic brain injury—a nationwide prospective surveillance study in Germany |
| title_full_unstemmed | Current practice of intracranial pressure monitoring in children with severe traumatic brain injury—a nationwide prospective surveillance study in Germany |
| title_short | Current practice of intracranial pressure monitoring in children with severe traumatic brain injury—a nationwide prospective surveillance study in Germany |
| title_sort | current practice of intracranial pressure monitoring in children with severe traumatic brain injury a nationwide prospective surveillance study in germany |
| topic | children severe traumatic brain injury intracranial pressure monitoring outcomes ICP neuromonitoring |
| url | https://www.frontiersin.org/articles/10.3389/fped.2024.1355771/full |
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