Treatment Trends and Inpatient Mortality in Isolated Severe Traumatic Brain Injury Using the National Trauma Data Bank

Helton, Matthew; Thomas, Kevin; Sexton, Kevin W.; Rodriguez, Analiz; Porter, Austin

doi:10.1016/j.wneu.2022.05.048

Cited by 4 publications

(3 citation statements)

References 21 publications

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“…Even though the guidelines have strong expert consensus regarding their recommendations on ICP monitoring in sTBI, the level of evidence underlying these recommendations is low 4,6,7 and it is still under debate whether ICP monitoring actually improves outcomes. While positive effects of diversion of cerebrospinal uid on outcomes have been reported [11][12][13] , other observational studies found no effect or even point in the opposite direction 14,15 . In the absence of su ciently powered prospective randomized controlled trials, it remains unclear whether these ndings truly re ect adverse effects of the interventions or the impossibility to completely adjust for confounding factors.…”

Section: Discussionmentioning

confidence: 95%

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. 2023

Preprint

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Background For 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. Methods Anonymized 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. Results Out 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%). Conclusion In 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. Trial registration German Clinical Trials Registry, DRKS00022807. Registered 11 August 2020 - Retrospectively registered, https://drks.de/search/de/trial/DRKS00022807

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Section: Discussionmentioning

confidence: 95%

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. 2023

Preprint

View full text Add to dashboard Cite

show abstract

“…15) A recent report from the United States also suggested that the introduction of ICP monitoring reduces the mortality of patients with severe TBI. 17) It is of particular note that the highest ICP during treatment was significantly lower in cases with favorable outcomes (22.1 vs. 39.6 mmHg) and was a significant independent factor for a favorable outcome in multivariate analysis. 15) In the receiver operating characteristic (ROC) curve analysis for the highest ICP performed for outcome, the area under the ROC curve for ICP was 0.708 (95% CI 0.648-0.768, p < 0.001), with a sensitivity of 65.2% and a specificity of 64.6% at a cutoff ICP of 22.5 mmHg.…”

Section: Is Icp Monitoring For Patients With Severe Tbi Useful?mentioning

confidence: 86%

Challenges in the Treatment of Severe Traumatic Brain Injury Based on Data in the Japan Neurotrauma Data Bank

Suehiro

Tanaka

Kawashima

et al. 2023

Neurol. Med. Chir.(Tokyo)

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The Japan Neurotrauma Data Bank is a source of epidemiological data for patients with severe traumatic brain injury (TBI) and is sponsored by the Japan Society of Neurotraumatology. In this report, we examined the changes in the treatment of severe TBI in Japan based on data of the Japan Neurotrauma Data Bank. Controlling and decreasing intracranial pressure (ICP) are the primary objective of severe TBI treatment. Brain-oriented whole-body control or neurocritical care, including control of cerebral perfusion pressure, respiration, and infusion, are also increasingly considered important because cerebral tissues require oxygenation to improve the outcomes of patients with severe TBI. The introduction of neurocritical care in Japan was delayed compared with that in Western countries. However, the rate of ICP monitoring increased from 28.0% in 2009 to 36.7% in 2015 and is currently likely to be higher. Neurocritical care has also become more common, but the functional prognosis of patients has not significantly improved in Japan. Changes in the background of patients with severe TBI suggest the need for improvement of acute-phase treatment for elderly patients. Appropriate social rehabilitation from the subacute to chronic phases and introduction of cellular therapeutics are also needed for patients with TBI.

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“…Even though the guidelines have strong expert consensus regarding their recommendations on ICP monitoring in sTBI, the level of evidence underlying these recommendations is low (4,6,7) and it is still under debate whether ICP monitoring actually improves outcomes. While positive effects of diversion of cerebrospinal fluid on outcomes have been reported (12)(13)(14), other observational studies found no effect or even point in the opposite direction (15,16). In the absence of sufficiently powered prospective randomized controlled trials, it remains unclear whether these findings truly reflect adverse effects of the interventions or the impossibility to completely adjust for confounding factors.…”

Section: Discussionmentioning

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.

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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

Treatment Trends and Inpatient Mortality in Isolated Severe Traumatic Brain Injury Using the National Trauma Data Bank

Cited by 4 publications

References 21 publications

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

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

Challenges in the Treatment of Severe Traumatic Brain Injury Based on Data in the Japan Neurotrauma Data Bank

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

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