Xue Shan, Zhang Zhe, Liu Yan
Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China.
West China School of Nursing, Sichuan University, Chengdu, China.
Front Neurol. 2025 Mar 17;16:1557820. doi: 10.3389/fneur.2025.1557820. eCollection 2025.
As Severe traumatic brain injury (TBI) is a major cause of pediatric morbidity and mortality. The clinical benefits of intracranial pressure (ICP) monitoring in pediatric TBI remain debated. This meta-analysis aims to assess the impact of ICP monitoring on outcomes in children with severe TBI.
Following PRISMA guidelines, a comprehensive search was conducted in PubMed, EMBASE, Cochrane Library, and Web of Science. Studies comparing pediatric severe TBI patients with and without ICP monitoring were included. Primary outcomes included in-hospital mortality and complications, while secondary outcomes included craniotomy/craniectomy rate, length of hospital stay and ICU stay, mechanical ventilation duration, and medical costs. Quality assessment was performed using the Methodological Index for Non-Randomized Studies (MINORS) for cohort studies. The weighted mean difference (WMD) for continuous variables and odds ratio (OR) for dichotomous variables were calculated, along with 95% confidence intervals (CIs). Meta-analysis was performed using RevMan 5.4.1 software.
Eight studies (12,987 patients) were included. ICP monitoring showed no significant impact on overall in-hospital mortality (OR, 1.14; = 0.65), though propensity score matching (PSM) studies indicated a lower mortality rate with ICP monitoring (OR, 0.62; = 0.005). However, ICP monitoring was associated with higher risks of infection-related (OR, 7.21; < 0.001) and respiratory complications (OR, 5.79; < 0.001), thromboembolic events (OR, 5.37; < 0.001), increased craniotomy/craniectomy rates (OR, 2.34; = 0.01), longer hospital (OR, 12.00; < 0.001) and ICU stays (OR, 7.82; < 0.001), extended mechanical ventilation durations (OR, 5.82; < 0.001), and higher medical costs (WMD, 10.49; = 0.006).
This meta-analysis found no overall reduction in in-hospital mortality with ICP monitoring in pediatric severe TBI, potentially due to baseline severity imbalances in retrospective studies. However, PSM studies suggest a mortality benefit, indicating that ICP monitoring may be effective when confounding is minimized. Increased complication risks, longer hospital/ICU stays, prolonged ventilation, and higher costs were associated with monitoring, though these may reflect injury severity rather than monitoring itself. Given the limitations of this study, these findings should be interpreted cautiously.
重度创伤性脑损伤（TBI）是儿童发病和死亡的主要原因。颅内压（ICP）监测在儿童TBI中的临床益处仍存在争议。本荟萃分析旨在评估ICP监测对重度TBI患儿预后的影响。
按照PRISMA指南，在PubMed、EMBASE、Cochrane图书馆和科学网进行了全面检索。纳入了比较有和没有ICP监测的儿童重度TBI患者的研究。主要结局包括住院死亡率和并发症，次要结局包括开颅/颅骨切除术率、住院时间和ICU住院时间、机械通气时间和医疗费用。使用队列研究的非随机研究方法学指数（MINORS）进行质量评估。计算连续变量的加权平均差（WMD）和二分变量的比值比（OR），以及95%置信区间（CI）。使用RevMan 5.4.1软件进行荟萃分析。
纳入了8项研究（12,987例患者）。ICP监测对总体住院死亡率没有显著影响（OR，1.14； = 0.65），尽管倾向评分匹配（PSM）研究表明ICP监测的死亡率较低（OR，0.62； = 0.005）。然而，ICP监测与感染相关（OR，7.21； < 0.001）和呼吸并发症（OR，5.79； < 0.001）、血栓栓塞事件（OR，5.37； < 0.001）的风险增加、开颅/颅骨切除术率增加（OR，2.34； = 0.01）、住院时间延长（OR，12.00； < 0.001）和ICU住院时间延长（OR，7.82； < 0.001）、机械通气时间延长（OR，5.82； < 0.001）以及医疗费用增加（WMD，10.49； = 0.006）相关。
本荟萃分析发现，在儿童重度TBI中，ICP监测并没有使住院死亡率总体降低，这可能是由于回顾性研究中基线严重程度不平衡所致。然而，PSM研究表明有死亡率获益，这表明当混杂因素最小化时，ICP监测可能是有效的。监测与并发症风险增加、住院/ICU住院时间延长、通气时间延长和费用增加相关，尽管这些可能反映的是损伤严重程度而非监测本身。鉴于本研究的局限性，这些发现应谨慎解读。
