Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI, USA.
Pediatr Crit Care Med. 2011 Nov;12(6):e350-6. doi: 10.1097/PCC.0b013e31820abc83.
To describe the beliefs and attitudes of U.S. neurosurgeons regarding the use of intracranial pressure monitors among comatose children with meningitis.
A questionnaire was administered by mail between March and July 2009, to a random sample of 500 adult neurosurgeons and to all 228 pediatric neurosurgeons in the Congress of Neurologic Surgeons.
None.
The response rate was 60%. Abnormal computed tomography scans, either with brain swelling or hydrocephalus, and older child age were likely to prompt neurosurgeons to consider monitoring intracranial pressure, whereas etiology of meningitis did not impact the decision to monitor intracranial pressure. Fifty-two percent of neurosurgeons believed computed tomography scans were inaccurate in detecting elevated intracranial pressure in comatose children with meningitis, 22% believed otherwise, and 26% were uncertain. Only 25% of neurosurgeons felt there was sufficient medical evidence to monitor intracranial pressure in comatose children with meningitis, with higher frequency among adult than pediatric (30% vs. 16%; p < .01) neurosurgeons. Eighty-one percent of neurosurgeons disagreed with the notion that comatose children with meningitis were too ill to benefit from placement of intracranial pressure monitors. Pediatric neurosurgeons reported a higher frequency than adult neurosurgeons of having placed more (more than five) intracranial pressure monitors in comatose children with meningitis (42% vs. 28%; p < .01).
Most neurosurgeons are willing to consider monitoring intracranial pressure among comatose children with meningitis in the presence of abnormal findings on computed tomography scan and with older patient age. These findings are instructive in view of the current uncertainty and equipoise in clinical practice regarding intracranial pressure monitoring in these critically ill children.
描述美国神经外科医生对患有脑膜炎的昏迷儿童使用颅内压监测器的信念和态度。
2009 年 3 月至 7 月期间，通过邮件向 500 名成年神经外科医生和神经外科医师协会的所有 228 名儿科神经外科医生发放问卷。
无。
回复率为 60%。异常的计算机断层扫描（无论是脑肿胀还是脑积水）和年龄较大的儿童更有可能促使神经外科医生考虑监测颅内压，而脑膜炎的病因并不影响监测颅内压的决定。52%的神经外科医生认为计算机断层扫描在检测患有脑膜炎的昏迷儿童颅内压升高时不准确，22%的神经外科医生则认为并非如此，26%的神经外科医生不确定。只有 25%的神经外科医生认为有足够的医学证据来监测患有脑膜炎的昏迷儿童的颅内压，成年神经外科医生的比例高于儿科神经外科医生（30%对 16%；p<.01）。81%的神经外科医生不同意昏迷的脑膜炎患儿病得太重而无法受益于颅内压监测器的观点。儿科神经外科医生报告称，与成年神经外科医生相比，他们在患有脑膜炎的昏迷儿童中放置了更多（超过 5 个）颅内压监测器的频率更高（42%对 28%；p<.01）。
大多数神经外科医生愿意考虑在计算机断层扫描发现异常和患者年龄较大的情况下对患有脑膜炎的昏迷儿童进行颅内压监测。这些发现对于目前在这些危重病儿童中监测颅内压的临床实践中的不确定性和平衡具有启示意义。
