Tilford JM, Simpson PM, Lensing S, Fiser DH; Association for Health Services Research. Meeting.

Abstr Book Assoc Health Serv Res Meet. 1999; 16: 382.

Center for Applied Research and Evaluation, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock 72205, USA.

RESEARCH OBJECTIVE: Most treatment protocols used in children following severe head injury have been extrapolated from adult data. The applicability of many adult treatment protocols in children remains unknown. Most importantly, conclusive data are lacking that demonstrate the aggressive management of severe head injuries in children with the use of intracranial pressure monitoring improves outcome - particularly in infants and young children. This study examines variation in the use of intracranial pressure monitoring and outcomes for head-injured children. STUDY DESIGN: Data from three pediatric intensive care units (PICUs) over an eighteen month period were used to develop estimates of admission mortality risk, a description of therapies and resources used during the ICU stay, and outcomes. Patients with intracranial pressure monitors placed within one hour of PICU admission were recorded along with daily information on intracranial monitoring. Relationship between admission monitoring, insurance status, race, and outcome were examined along with observed and expected mortality rates for each PICU. PRINCIPAL FINDINGS: Rates of monitoring on admission and outcomes varies substantially across the three PICUs. Three-fold increases in mortality of children aged 0-4 were found in the two units that were less aggressive in monitoring on admission. There was no difference in the use of intracranial pressure monitoring by race or insurance status. Multivariate analysis indicated a substantial protective effect of admission intracranial pressure monitoring on mortality. Including other therapies in the model did not affect the estimated relationship. Standardized mortality ratios varied from 0.66 to 1.20 across the three PICUs. CONCLUSIONS: These findings suggest substantial benefit from the early initiation of intracranial pressure monitoring in severely head-injured children. Evidence demonstrated improved outcomes from the use of intracranial pressure monitoring could reduce practice variations and improve the quality of care. IMPLICATIONS FOR POLICY, DELIVERY, OR PRACTICE: The acute care management of head injury is a classic example of how research on children has lagged far behind that of adults. Guidelines for the management of head-injured adults are used in many centers across the U.S., yet no evidence-based guidelines exist for treatment of children with head injuries. Research on children with head injuries is hampered by known obstacles including the need for large multi-institution samples and a lack of valid outcome measures for infants and young children.

Publication Types:

• Meeting Abstracts

Keywords:

• Adult
• Child
• Clinical Protocols
• Craniocerebral Trauma
• Humans
• Infant
• Intensive Care Units
• Intensive Care Units, Pediatric
• Intracranial Pressure
• Monitoring, Physiologic
• United States
• utilization
• hsrmtgs

Other ID:

• HTX/20603069

UI: 102194758

From Meeting Abstracts