(1575) ICP Monitoring Improves Mortality but Not Functional Outcomes in Pediatric TBI: A Multicenter Study

Introduction: The impact of invasive intracranial pressure (ICP) monitoring on clinical outcomes in pediatric traumatic brain injury (TBI) remains controversial. We aimed to investigate the association between invasive ICP monitoring and in-hospital mortality, and functional outcomes among children with severe TBI.

Methods: We performed a multicenter observational study from January 2014 to August 2022 across 23 Pediatric Intensive Care Units in Asia and Latin America. We recruited children < 18 years old with severe TBI who presented within 24 hours of injury and who survived past 24 hours of admission. We compared characteristics and outcomes between children with and without invasive ICP monitoring. We performed multivariable logistic regression for in-hospital mortality, Pediatric Cerebral Performance Category (PCPC) at discharge, and Glasgow Outcome Score-Extended (GOS-E) at 3 months post-discharge, adjusting for age, admission GCS, male sex, multiple traumas, subdural hemorrhage, and subarachnoid hemorrhage.

Results: Among 491 children, 112 (22.8%) received invasive ICP monitoring. Patients who received ICP monitoring were more likely to have subarachnoid (47.7% vs. 26.8%, p< 0.001) and subdural hemorrhage (39.6% vs. 28.5%, p=0.026). Those with ICP monitoring received more concomitant treatments within 24 hours of admission, including intubation (98.2% vs. 88.1%, p=0.001), prophylactic anti-epileptics (75.9% vs. 64.9%, p=0.029), paralytics (33.0% vs. 15.3%, p< 0.001), inotropes (50.0% vs. 31.4%, p< 0.001), sedatives (92.9% vs. 69.4%, p< 0.001), and decompressive craniectomy (25.9% vs. 7.4%, p< 0.001). Invasive ICP monitoring was associated with reduced in-hospital mortality [adjusted odd ratio (aOR) 0.38, 95% confidence interval (95%CI) 0.17-0.80, p=0.011], but was associated with poor GOS-E at 3 months post-discharge (aOR 1.78, 95%CI 1.02-3.35, p=0.049). There was no association between ICP monitoring and discharge PCPC outcome among children with severe TBI.

Conclusions: While associated with reduced mortality, invasive ICP monitoring was not associated with improved functional outcomes among survivors. Future research should investigate the role and effectiveness of ICP monitoring in specific intracranial injuries.