Brensing Pia, Greve Sandra, Hojeij Rayan, Dammann Philipp, Felderhoff-Müser Ursula, Dohna-Schwake Christian, Bruns Nora
Department of Pediatrics I, Neonatology, Pediatric Intensive Care Medicine, and Pediatric Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
C-TNBS, Centre for Translational Neuro- and Behavioral Sciences, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
Front Pediatr. 2024 Feb 9;12:1355771. doi: 10.3389/fped.2024.1355771. eCollection 2024.
For management of severe traumatic brain injuries (sTBI) in children, the overall level of evidence to guide diagnostic and therapeutic procedures is low. Since 2016, international guidelines have subsequently suggested invasive intracranial pressure (ICP) monitoring in patients with initial Glasgow Coma Scale (GCS) ≤8. In Germany, ICP monitoring was an individual case decision from 2011 until the 2022 update of the German pediatric TBI guideline. The aim of this study was to evaluate current clinical practice of invasive ICP monitoring in Germany in children <10 years with respect to guideline recommendations.
Anonymized clinical data on sTBI cases <10 years of age were collected in a nationwide prospective surveillance study via the German Pediatric Surveillance Unit ESPED from July 2019 until June 2022. Inclusion criteria for the surveillance study were sTBI (initial GCS ≤8) or neurosurgery following TBI. For this analysis, only cases with GCS ≤8 were subject to the present analysis. Descriptive analyses were performed to assess the proportion of ICP monitored patients and describe the cohort.
Out of 217 reported cases, 102 cases met the inclusion criteria and thus qualified for ICP monitoring. Of these, 37 (36%) received ICP monitoring. Monitored patients were older, had lower median GCS values at presentation (4 vs. 5), higher mortality (32% vs. 22%), and were more frequently diagnosed with cerebral edema (68% vs. 37%).
In children <10 years with sTBI, the present clinical management regarding ICP monitoring deviates from the current German national and international guidelines. The reasons remain unclear, with the low level of evidence in the field of ICP monitoring and the recency of changes in guideline recommendations as potential contributors. Prospective interventional studies should elucidate the benefit of ICP monitoring and ICP directed therapies to provide evidence-based recommendations on ICP monitoring.
对于儿童重型创伤性脑损伤（sTBI）的管理，指导诊断和治疗程序的总体证据水平较低。自2016年以来，国际指南随后建议对初始格拉斯哥昏迷量表（GCS）≤8的患者进行有创颅内压（ICP）监测。在德国，从2011年到2022年德国儿科创伤性脑损伤指南更新，ICP监测一直是个别病例的决定。本研究的目的是根据指南建议评估德国10岁以下儿童有创ICP监测的当前临床实践。
通过德国儿科监测单位ESPED，在2019年7月至2022年6月的一项全国性前瞻性监测研究中收集了10岁以下sTBI病例的匿名临床数据。监测研究的纳入标准为sTBI（初始GCS≤8）或创伤性脑损伤后的神经外科手术。对于本分析，仅对GCS≤8的病例进行当前分析。进行描述性分析以评估接受ICP监测的患者比例并描述该队列。
在报告的217例病例中，102例符合纳入标准，因此有资格进行ICP监测。其中，37例（36%）接受了ICP监测。接受监测的患者年龄较大，就诊时的GCS中位数较低（4对5），死亡率较高（32%对22%），并且更频繁地被诊断为脑水肿（68%对37%）。
在10岁以下的sTBI儿童中，目前关于ICP监测的临床管理与当前德国国家和国际指南存在偏差。原因尚不清楚，ICP监测领域的证据水平较低以及指南建议变化的近期性可能是促成因素。前瞻性干预研究应阐明ICP监测和ICP导向治疗的益处，以提供关于ICP监测的循证建议。
