Frequency of and factors associated with emergency department intracranial pressure monitor placement in severe paediatric traumatic brain injury

Kannan, Nithya; Quistberg, Alex; Wang, Jin; Groner, Jonathan I.; Mink, Richard; Wainwright, Mark S.; Bell, Michael J.; Giza, Christopher C.; Zatzick, Douglas; Ellenbogen, Richard G.; Boyle, Linda Ng; Mitchell, Pamela H.; Vavilala, Monica S.

doi:10.1080/02699052.2017.1346296

Cited by 6 publications

(2 citation statements)

References 28 publications

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“…The most recent iteration of the guidelines offers only a Level III recommendation stating ICP monitoring is suggested for children with sTBI. 50 North American practice surveys of ICP monitoring in children with sTBI meeting recommended monitoring criteria that found ICP monitoring rates to average 23%, 44,45,47,48,[51][52][53][54][55] with substantial between-hospital variation. 45,46 This variability could not be accounted for by patient-level factors or hospital characteristics supporting the presence of substantial clinical equipoise.…”

Section: Rationale and Background Informationmentioning

confidence: 99%

Development of a Randomized Trial Comparing ICP-Monitor–Based Management of Severe Pediatric Traumatic Brain Injury to Management Based on Imaging and Clinical Examination Without ICP Monitoring–Study Protocol

Chesnut,

Temkin,

Pridgeon

et al. 2023

Neurosurgery

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BACKGROUND AND OBJECTIVES: Traumatic brain injury (TBI) is a major global public health problem. It is a leading cause of death and disability in children and adolescents worldwide. Although increased intracranial pressure (ICP) is common and associated with death and poor outcome after pediatric TBI, the efficacy of current ICP-based management remains controversial. We intend to provide Class I evidence testing the efficacy of a protocol based on current ICP monitor–based management vs care based on imaging and clinical examination without ICP monitoring in pediatric severe TBI. METHODS: A phase III, multicenter, parallel-group, randomized superiority trial performed in intensive care units in Central and South America to determine the impact on 6-month outcome of children aged 1–12 years with severe TBI (age-appropriate Glasgow Coma Scale score ≤8) randomized to ICP-based or non-ICP–based management. EXPECTED OUTCOMES: Primary outcome is 6-month Pediatric Quality of Life. Secondary outcomes are 3-month Pediatric Quality of Life, mortality, 3-month and 6-month Pediatric extended Glasgow Outcome Score, intensive care unit length of stay, and number of interventions focused on treating measured or suspected intracranial hypertension. DISCUSSION: This is not a study of the value of knowing the ICP in sTBI. This research question is protocol-based. We are investigating the added value of protocolized ICP management to treatment based on imaging and clinical examination in the global population of severe pediatric TBI. Demonstrating efficacy should standardize ICP monitoring in severe pediatric TBI. Alternate results should prompt reassessment of how and in which patients ICP data should be applied in neurotrauma care.

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Section: Rationale and Background Informationmentioning

confidence: 99%

Development of a Randomized Trial Comparing ICP-Monitor–Based Management of Severe Pediatric Traumatic Brain Injury to Management Based on Imaging and Clinical Examination Without ICP Monitoring–Study Protocol

Chesnut,

Temkin,

Pridgeon

et al. 2023

Neurosurgery

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“…It has been proposed that the anterior fontanelle, the soft area of the unformed skull on a new-born baby, can be used as a site for detecting the increased intracranial pressure (ICP) of infants [1,2]. ICP levels for normal infants are 5-10 mbar and the ICP beyond these values may be the clinical expression of several intracranial pathologies [3][4][5][6][7]. In addition, increased ICP of infants not only interferes with normal brain development but also causes the fontanelle to bulge out significantly (Figure 1A).…”

Section: Introductionmentioning

confidence: 99%

Wearable Intracranial Pressure Monitoring Sensor for Infants

et al. 2021

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Monitoring of intracranial pressure (ICP) is important for patients at risk of raised ICP, which may indicate developing diseases in brains that can lead to brain damage or even death. Monitoring ICP can be invaluable in the management of patients suffering from brain injury or hydrocephalus. To date, invasive measurements are still the standard method for monitoring ICP; however, these methods can not only cause bleeding or infection but are also very inconvenient to use, particularly for infants. Currently, none of the non-invasive methods can provide sufficient accuracy and ease of use while allowing continuous monitoring in routine clinical use at low cost. Here, we have developed a wearable, non-invasive ICP sensor that can be used like a band-aid. For the fabrication of the ICP sensor, a novel freeze casting method was developed to encapsulate the liquid metal microstructures within thin and flexible polymers. The final thickness of the ICP sensor demonstrated is 500 µm and can be further reduced. Three different designs of ICP sensors were tested under various pressure actuation conditions as well as different temperature environments, where the measured pressure changes were stable with the largest stability coefficient of variation being only CV = 0.0206. In addition, the sensor output values showed an extremely high linear correlation (R2 > 0.9990) with the applied pressures.

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Watching the Brain: an Overview of Neuromonitoring Systems and Their Utility in the Emergency Department

Grahf

Binz

Belle

et al. 2020

Curr Emerg Hosp Med Rep

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Frequency of and factors associated with emergency department intracranial pressure monitor placement in severe paediatric traumatic brain injury

Cited by 6 publications

References 28 publications

Development of a Randomized Trial Comparing ICP-Monitor–Based Management of Severe Pediatric Traumatic Brain Injury to Management Based on Imaging and Clinical Examination Without ICP Monitoring–Study Protocol

Development of a Randomized Trial Comparing ICP-Monitor–Based Management of Severe Pediatric Traumatic Brain Injury to Management Based on Imaging and Clinical Examination Without ICP Monitoring–Study Protocol

Wearable Intracranial Pressure Monitoring Sensor for Infants

Watching the Brain: an Overview of Neuromonitoring Systems and Their Utility in the Emergency Department

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