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Prediction of raised intracranial pressure complicating severe traumatic brain injury in children: implications for trial design
Published in:
Pediatr Crit Care Med, Vol: 9, Page: 8-14
Publication Date:
January 2008
Aims & Objectives:
This study aimed to describe current patterns of management of raised intracranial pressure in traumatic brain injury relevant to clinician buy-in to possible randomized controlled trials of treatments of raised ICP
Abstract:
OBJECTIVES: To describe current patterns of management of raised intracranial pressure (ICP) in traumatic brain injury relevant to clinician buy-in to possible randomized controlled trials of treatments of raised ICP. To examine the feasibility of early identification of children at sufficient risk of developing raised ICP to permit a uniform approach between centers to the initiation of ICP monitoring. This would permit quantification of ICP elevation and enrollment as appropriate to randomized controlled trials of raised ICP interventions. DESIGN: Logistic regression modeling of death before pediatric intensive care unit discharge and decision tree and logistic regression of development of raised ICP through analysis of a prospectively collected, standardized, national data set. SETTING: Pediatric intensive care units in the United Kingdom and Eire. PATIENTS: Patients were 501 children <16 yrs of age primarily admitted to intensive care unit for management of traumatic brain injury in the United Kingdom and Eire between February 2001 and August 2003. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The data analyzed included demographic, acute physiologic, and cranial imaging variables. Death was associated with both raised ICP and the nonmeasurement of ICP. In a subset of 199 patients, an empirically derived decision rule predicted the development of raised ICP at any point during ICU admission with sensitivity of 73% and specificity of 74% (positive predictive value 82% and negative predictive value 63%). Logistic regression modeling performed comparably. The decision rule also predicted raised ICP in 20% of children not undergoing ICP monitoring. CONCLUSIONS: Simple models based on early clinical data may predict the development of raised ICP sufficiently well to encourage a consistent approach between centers to initiation of ICP monitoring. We estimate studies designed to detect reductions in ICU mortality will require >320 children per arm, although this figure may be higher if more conservative assumptions are made.
Authors:
Study Type:
Study Papers » Case Study » Descriptive Studies - Without a comparision
Notes:
UK Paediatric Traumatic Brain Injury Study Group Paediatric Intensive Care Society Study Group (PICSSG)
Categories:
raised intracranial pressure; traumatic brain injury
International Classification:
Injury, poisoning and certain other consequences of external causes - traumatic brain injury
Keywords:
- Adolescent
- Brain Injuries/mortality/ physiopathology
- Child
- Child, Preschool
- Female
- Great Britain/epidemiology
- Hospital Mortality
- Humans
- Intensive Care Units, Pediatric
- Intracranial Hypertension/ complications/drug therapy
- Ireland/epidemiology
- Logistic Models
- Male
- Prognosis
- Prospective Studies
- Randomized Controlled Trials as Topic
- Research Design
- Risk Assessment
Geography:
Republic of Ireland and the United Kingdom (UK & Ireland)