PDF(Pubmed)
Abstract：
UNASSIGNED: 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.
UNASSIGNED: 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.
UNASSIGNED: 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%).
UNASSIGNED: 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.
UNASSIGNED: 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.
UNASSIGNED: 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%).
UNASSIGNED: 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.
摘要：
■对于儿童严重创伤性脑损伤（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,ICP监测是2011年至2022年德国儿科TBI指南更新之前的个案决定。这项研究的目的是根据指南建议评估德国10岁以下儿童的侵入性ICP监测的当前临床实践。
■从2019年7月至2022年6月，通过德国儿科监测单位ESPED在全国范围内的前瞻性监测研究中收集了年龄<10岁的sTBI病例的匿名临床数据。监测研究的纳入标准是sTBI（初始GCS≤8）或TBI后的神经外科手术。对于这个分析，本分析仅对GCS≤8的病例进行分析.进行描述性分析以评估ICP监测患者的比例并描述队列。
■在217例报告病例中，102例符合纳入标准，因此符合ICP监测条件。其中,37(36%)接收ICP监测。被监测的病人年龄较大，演示时GCS中值较低(4与5),更高的死亡率（32%vs.22%），并且更常被诊断为脑水肿(68%vs.37%）。
■在<10岁的sTBI儿童中，目前关于ICP监测的临床管理与德国目前的国家和国际指南有偏差.原因尚不清楚,由于ICP监测领域的证据水平较低，并且指南建议的变化是潜在的贡献者。前瞻性介入研究应阐明ICP监测和ICP定向治疗的益处，以提供基于证据的ICP监测建议。
■从2019年7月至2022年6月，通过德国儿科监测单位ESPED在全国范围内的前瞻性监测研究中收集了年龄<10岁的sTBI病例的匿名临床数据。监测研究的纳入标准是sTBI（初始GCS≤8）或TBI后的神经外科手术。对于这个分析，本分析仅对GCS≤8的病例进行分析.进行描述性分析以评估ICP监测患者的比例并描述队列。
■在217例报告病例中，102例符合纳入标准，因此符合ICP监测条件。其中,37(36%)接收ICP监测。被监测的病人年龄较大，演示时GCS中值较低(4与5),更高的死亡率（32%vs.22%），并且更常被诊断为脑水肿(68%vs.37%）。
■在<10岁的sTBI儿童中，目前关于ICP监测的临床管理与德国目前的国家和国际指南有偏差.原因尚不清楚,由于ICP监测领域的证据水平较低，并且指南建议的变化是潜在的贡献者。前瞻性介入研究应阐明ICP监测和ICP定向治疗的益处，以提供基于证据的ICP监测建议。
