Frequency of intracranial pressure monitoring in infants and young toddlers with traumatic brain injury*

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Abstract
Objective: To examine the use of intracranial pressure monitors and treatments for elevated intracranial pressure in brain-injured children of <2 yrs of age and compare them with the recently published management guidelines. Design: Prospective, population-based study. Setting: All pediatric intensive care units in the state of North Carolina. Patients: All patients of <24 months of age admitted to a pediatric intensive care unit with a traumatic brain injury between January 2000 and December 2001. Interventions: None. Measurements and Main Results: Use of intracranial pressure monitoring devices and treatments for elevated intracranial pressure were measured. There were 136 children admitted to a pediatric intensive care unit with brain injury. A total of 54 (39.7%) had an admission Glasgow Coma Score of ≤8, and 80% were infants. Thirty-three percent of children with a Glasgow Coma Score of ≤8 received monitoring. Hyperosmolar therapy was the most frequently used treatment (57.1%). Treatment for elevated intracranial pressure was more common in, but not limited to, children with monitors. Logistic-regression modeling showed that children of ≤12 months of age had an odds ratio of 0.2 (95% confidence interval, 0.1–0.6) of receiving a monitor compared with children aged 12–24 months. Conclusions: Brain injury in young children may lead to many years of lost quality of life. The utility of monitoring intracranial pressure in infants has not been well established, which may be a reason for its low use. As most infants with traumatic brain injury survive, high-quality studies with neurodevelopmental measures as the primary outcome are urgently needed to document best practice in this subpopulation.