Das Traumaregister der Deutschen Gesellschaft für Unfallchirurgie im internationalen Vergleich

Oestern, H.-J.; Jansen, T.; Polytrauma, A. G.

doi:10.1007/978-3-642-59573-8_149

Cited by 1 publication

(1 citation statement)

References 12 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Adherence to specific therapy recommendations has reduced mortality and improved functional outcome after severe traumatic brain injury (sTBI) (4). Immediate protective intubation, normalization of vital parameters (5), and basic neuroprotective measures are the cornerstones of sTBI management (6). Additionally, invasive intracranial pressure (ICP) monitoring is suggested for comatose [Glasgow Coma Scale (GCS) value ≤8] or continuously sedated patients by international guidelines and in the 2022 update of the German national guideline with strong consensus but low level of evidence (4,6,7).…”

Section: Introductionmentioning

confidence: 99%

Current practice of intracranial pressure monitoring in children with severe traumatic brain injury—a nationwide prospective surveillance study in Germany

Brensing,

Greve,

Hojeij

et al. 2024

Front. Pediatr.

View full text Add to dashboard Cite

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.

show abstract