Best Pediatric Clinical Abstract - Evaluating the Impact of Surgical Interventions and ICP Monitoring on Outcomes in Pediatric Severe TBI

Introduction: Traumatic brain injury (TBI) remains a significant concern in pediatric care due to its potential to cause lasting morbidity and mortality. We evaluate the impact of intracranial pressure (ICP) monitoring and surgical interventions on the outcomes in pediatric severe TBI patients.

Methods: We conducted a single-center ambispective cohort study on severe TBI pediatric patients from a Level I trauma center. Using inverse probability weighting (IPW) regression models and propensity matching, we assessed PILOT scores, survival, length of hospital stay (LOS), and 6-month functional outcomes via the Glasgow Outcome Scale – Extended (GOS-E) among four patient subgroups: Surgery with and without ICP monitoring (Surg+ICP / Surg-NoICP), and No surgery with and without ICP monitoring (No Surg+ICP / No Surg-No ICP).

Results: We present a large analysis of 634 children with severe TBI. All groups had significantly lower PILOT scores with the order from greatest to least being Surg+ICP (reference), Surg-NoICP (-1.85), No Surg+ICP (-3.87), No Surg-NoICP (-7.67) according to the regression. Compared to Surg+ICPm, both No Surg+ICP (OR = 0.31, p = 0.04) and No Surg-NoICP (OR = 0.24, p < 0.001) had significantly lower survival. There was no difference in survival when comparing the Surg+ICP and Surg-NoICP groups (p = 0.70). Reduction in LOS was seen in the No Surg-NoICP (-7.96 days) and Surg-NoICP (-4.82 days) group while increased in the No Surg+ICP group (+4.88 days). Regarding functional outcomes, No Surg-NoICP had significantly lower GOS-E at 6 months compared to the Surg+ICP group (OR = 0.54, p = 0.03). There was no difference in functional outcomes when comparing Surg+ICP and Surg-NoICP (p = 0.19).

Conclusion : Surgical interventions significantly benefit survival and functional recovery in pediatric TBI patients. Our results suggest more work is needed to optimize outcomes for children undergoing ICP monitoring after decompressive hemicraniectomy.