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Intracranial pressure complicating severe traumatic brain injury in children: monitoring and management

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Abstract

Objective

To identify factors associated with the use of intracranial pressure (ICP) monitoring and to establish which ICP-targetted therapies are being used in children with severe traumatic brain injury (TBI) in the United Kingdom. To evaluate current practice against recently published guidelines.

Design and setting

Prospective data collection of clinical and demographic information from paediatric and adult intensive care units in the UK and Ireland admitting children (< 16 years) with TBI between February 2001 and August 2003.

Results

Detailed clinical information was obtained for 501 children, with information on the use of ICP monitoring available in 445. ICP monitoring was used in only 59% (75/127) of children presenting with an emergency room Glasgow Coma Scale of 8 or below. Large between centre variation was seen in the use of ICP monitoring, independent of severity of injury. There were 86 children who received ICP-targetted therapies without ICP monitoring. Wide between centre variation was found in the use of ICP-targetted therapies and in general aspects of management, such as fluid restriction, the use of muscle relaxants and prophylactic anticonvulsants. Intra-ventricular catheters are rarely placed (6% of cases); therefore cerebrospinal fluid drainage is seldom used as a first-line therapy for raised ICP. Jugular venous bulb oximetry (4%), brain microdialysis (< 1%) and brain tissue oxygen monitoring (< 1%) are rarely used in current practice. Contrary to published guidelines, moderate to severe hyperventilation is being used without monitoring for cerebral ischaemia.

Conclusions

There is an urgent need for greater standardisation of practice across UK centres admitting children with severe TBI.

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Acknowledgements

We are grateful to all the staff of PICUs who completed data collection forms, to Dr. Kathy Rowan of ICNARC for supplying data on paediatric admissions to adult ICUs, and to Naveed Hussain, Helen Sherry and Neil Hallworth for database design, data entry and preliminary data processing. The UK Paediatric Traumatic Brain Injury Study Steering Group consists of: K. Morris (Chair), R. Appleton, M. Crouchman, R. Forsyth, C. Hawley, M. Marsh, P. May, P. McKinney, J. Middleton, R. Parslow, J. Punt, T. Ralph and R. Tasker. Participating centres and investigators were: Addenbrooke's Hospital (R. Tasker), Alder Hey Children's Hospital (R. Sarginson), Antrim Hospital (A. Ferguson), Beaumont Hospital, Dublin (E. Keane), Birmingham Children's Hospital (K. Morris), Bristol Children's Hospital (J. Fraser), City General Hospital, Stoke (J. Alexander), Derriford Hospital, Plymouth (S. Ferguson), Great Ormond St. Hospital (M. Kenny, D. Lutman), Guy's Hospital (A. Durward), Hull Royal Infirmary (H. Klonin), John Radcliffe Hospital (A. Shefler, C. Killick), King's College Hospital (D. Prior, l. Edwards, Y. Egberongbe), Leeds General Infirmary (T. Chater, M. Darowski), Leicester Royal Infirmary (P. Barry), Queen's Medical Centre, Nottingham (P. Khandelwal), James Cook University Hospital (A. Robinson), Newcastle General Hospital (R. Forsyth), Royal Belfast Hospital for Sick Children (B. Taylor), Royal Berkshire Hospital (A. Maunganidze), Royal Devon & Exeter Hospital (J. Purday), Royal Hospital for Sick Children, Edinburgh (M. Lo, D. Simpson), Royal Hospital for Sick Children, Glasgow (P. Cullen), Royal London Hospital (P. Withington), Royal Manchester Children's Hospital (D. Stewart, M. Samuels), Royal Preston Hospital (P. Tomlin), Sandwell Hospital (J. Bellin), Sheffield Children's Hospital (T. Ralph), Southampton General Hospital (C. Boyles), Southern General Hospital, Glasgow (D. Snaddon, A. Wagstaff), St. Georges Hospital (S. Skellett), University Hospital of Wales (M. Gajraj), Walsgrave Hospital (M. Christie), Walton Centre for Neurosurgery (E. Wright).

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Correspondence to Kevin P. Morris.

Additional information

This study was supported by grants from the Paediatric Intensive Care Society, Birmingham Children's Hospital Research Foundation and the Warwick University Research and Teaching Development Fund.

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Morris, K.P., Forsyth, R.J., Parslow, R.C. et al. Intracranial pressure complicating severe traumatic brain injury in children: monitoring and management. Intensive Care Med 32, 1606–1612 (2006). https://doi.org/10.1007/s00134-006-0285-4

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  • DOI: https://doi.org/10.1007/s00134-006-0285-4

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