What question did this study set out to answer?

This analysis aims to investigate the impact of different ICP monitoring techniques on outcomes in pediatric severe traumatic brain injury.

April 4, 2026

A nationwide comparison of intracranial pressure monitoring devices in pediatric severe traumatic brain injury: Impact on surgical intervention and mortality

Key Points

This analysis aims to investigate the impact of different ICP monitoring techniques on outcomes in pediatric severe traumatic brain injury.
Retrospective analysis of data from the American College of Surgeons Trauma Quality Improvement Program (2017-2021)
Included pediatric trauma patients with severe brain injuries receiving invasive ICP monitoring for at least 24 hours
Patients were divided into two groups based on the type of ICP monitoring: EVD or IPM
Applied multivariable regression analysis to assess outcomes including mortality and surgical interventions.
Out of 4,250 patients, the overall mortality rate was 20% with no significant difference between EVD and IPM groups (p = 0.432)
46% of patients with EVD required surgical intervention compared to 56.9% with IPM (p < 0.001)
EVD was associated with a 25% reduction in mortality (adjusted odds ratio 0.750; p = 0.019)
EVD also resulted in a 30% reduction in need for surgical interventions (adjusted odds ratio 0.702; p < 0.001).

Abstract

INTRODUCTION: Traumatic brain injury is a leading cause of mortality in pediatric trauma, and intracranial pressure (ICP) monitoring is recommended in severe cases. Current guidelines do not favor one monitoring technique over another, and while combined approaches may offer benefits, individual effect of each technique on outcomes remains unclear. The study aim is to analyze differences in invasive monitors. METHODS: This is analysis of American College of Surgeons Trauma Quality Improvement Program (2017–2021). We included all pediatric (younger than 18 years) trauma patients with severe traumatic brain injury who received invasive ICP monitoring and were admitted for at least 24 hours. Patients were stratified based on type of ICP monitoring: those with an extraventricular drain (EVD) or an intraparenchymal monitor (IPM). Patients who received both monitoring devices were excluded. Primary outcomes included mortality and need for surgical intervention. Multivariable regression analysis was performed. RESULTS: A total of 4,250 met our inclusion criteria. The median age was 13 years, with 67% being male. The median Injury Severity Score was 27. Majority of patients (64.6%) underwent IPM placement. Distribution of pediatric trauma center verification differed between groups (IPM had a higher proportion at pediatric Level II centers, 15.9% vs. 10.6%, while EVD had a higher proportion at pediatric Level III/below, 50.9% vs. 45.2%; p < 0.001). Overall rate of mortality was 20% with no significant differences between the two groups ( p = 0.432). However, patients in EVD group had a lower rate of surgical intervention (EVD: 46% vs. IPM: 56.9%, p < 0.001). On multivariable regression analysis, EVD was independently associated with decreased mortality (adjusted odds ratio, 0.750; p = 0.019) and need for surgical intervention (adjusted odds ratio, 0.702; p < 0.001). CONCLUSION: Despite lack of guidelines on choice of ICP monitoring for pediatric patients, EVD placement alone was associated with 30% reduction in need for surgical intervention and 25% lower mortality. These findings highlight the need to further evaluate relative benefits of EVD versus IPM in reducing surgical interventions in this population. ( J Trauma Acute Care Surg . 2026;00: 00–00. Copyright © 2026 Wolters Kluwer Health, Inc. All rights reserved.) LEVEL OF EVIDENCE: Therapeutic/Care Management; Level IV.

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Cite This Study

Stewart et al. (Tue,) studied this question.

synapsesocial.com/papers/69d0af36659487ece0fa5231 https://doi.org/https://doi.org/10.1097/ta.0000000000004893

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