Odetola Folafoluwa O, Tilford John M, Davis Matthew M
Division of Pediatric Critical Care Medicine, Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI 48109, USA.
Pediatrics. 2006 Jun;117(6):1893-900. doi: 10.1542/peds.2005-2179.
Our goal was to describe patient and hospital characteristics associated with the use of intracranial pressure monitors and outcomes in critically ill children with meningitis.
This was a retrospective cohort study of children 0 to 17 years of age hospitalized with meningitis and requiring mechanical ventilation using the 1997 and 2000 Kids' Inpatient Database. We generated national estimates of rates of intracranial pressure monitoring and in-hospital mortality by patient and hospital characteristics, and compared in-hospital mortality, hospital length of stay, and total charges for children who received an intracranial pressure monitor with those who did not.
There were an estimated 1067 and 1170 hospitalizations nationally for childhood meningitis requiring mechanical ventilation in 1997 and 2000, respectively. Most (79%) of the hospitalizations involved infants. Overall, intracranial-pressure monitors were used in 7% of hospitalizations for meningitis, with the highest rates in children aged 5 to 17 years and lowest rates in children <1 year. In-hospital mortality was 19.6%, highest in children aged 5 to 17 years and in children with pneumococcal infections. In multivariate regression analyses, intracranial pressure monitor use was positively associated with age, patient volume, and hospitals located in the West census region. In-hospital mortality was associated with increasing age, hospitalization in the year 2000, self-pay/other insurance status, and pneumococcal meningitis. There was no difference in hospital mortality associated with use of intracranial pressure monitors, but both length of stay and log-transformed total hospital charges were significantly higher in the group that received an intracranial-pressure monitor.
Intracranial pressure monitoring for the treatment of critically ill children with meningitis varies by census region, the number of cases treated, and patient age. The use of intracranial pressure monitoring was not statistically associated with mortality in this national sample.
我们的目标是描述与颅内压监测器使用相关的患者和医院特征，以及患有脑膜炎的重症儿童的治疗结果。
这是一项回顾性队列研究，研究对象为1997年和2000年使用儿童住院数据库住院治疗脑膜炎且需要机械通气的0至17岁儿童。我们根据患者和医院特征对颅内压监测率和住院死亡率进行了全国性估计，并比较了接受颅内压监测器的儿童与未接受监测器的儿童的住院死亡率、住院时间和总费用。
1997年和2000年全国分别估计有1067例和1170例儿童脑膜炎住院患者需要机械通气。大多数（79%）住院患者为婴儿。总体而言，7%的脑膜炎住院患者使用了颅内压监测器，5至17岁儿童的使用率最高，<1岁儿童的使用率最低。住院死亡率为19.6%，5至17岁儿童和肺炎球菌感染儿童的死亡率最高。在多变量回归分析中，颅内压监测器的使用与年龄、患者数量以及位于西部普查地区的医院呈正相关。住院死亡率与年龄增长、2000年住院、自费/其他保险状况以及肺炎球菌性脑膜炎有关。使用颅内压监测器与医院死亡率没有差异，但接受颅内压监测器的组的住院时间和经对数转换的总住院费用均显著更高。
用于治疗患有脑膜炎的重症儿童的颅内压监测因普查地区、治疗病例数和患者年龄而异。在这个全国性样本中，颅内压监测的使用与死亡率没有统计学关联。
