Parental involvement in decision making about intracranial pressure monitor placement in children with traumatic brain injury

2020 ◽  
Vol 25 (2) ◽  
pp. 183-191
Author(s):  
Rebekah Marsh ◽  
Daniel D. Matlock ◽  
Julie A. Maertens ◽  
Alleluiah Rutebemberwa ◽  
Megan A. Morris ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Decision Making ◽  
Brain Injury ◽  
Intracranial Pressure ◽  
Parental Involvement ◽  
Information Needs ◽  
Pediatric Trauma ◽  
Decision Support Tool ◽  
Pressure Monitor ◽  
Support Tool

OBJECTIVELittle is known about how parents of children with traumatic brain injury (TBI) participate or feel they should participate in decision making regarding placing an intracranial pressure (ICP) monitor. The objective of this study was to identify the perspectives and decisional or information needs of parents whose child sustained a TBI and may require an ICP monitor.METHODSThis was a qualitative study at one US level I pediatric trauma center. The authors conducted in-depth semistructured interviews with 1) parents of critically injured children who have sustained a TBI and 2) clinicians who regularly care for children with TBI.RESULTSThe authors interviewed 10 parents of 7 children (60% were mothers and 80% were white) and 28 clinicians (17 ICU clinicians and 11 surgeons). Overall, the authors found concordance between and among parents and clinicians about parental involvement in ICP monitor decision making. Parents and clinicians agreed that decision making about ICP monitoring in children who have suffered TBI is not and should not be shared between the parents and clinicians. The concordance was represented in 3 emergent themes. Parents wanted transparency, communication, and information (theme 2), but the life-threatening context of this decision (theme 1) created an environment where all involved reflected a clear preference for paternalism (theme 3).CONCLUSIONSThe clear and concordant preference for clinician paternalistic decision making coupled with the parents’ needs to be informed suggests that a decision support tool for this decision should be clinician facing and should emphasize transparency in collaborative decision making between clinicians.

Decision-Making About Intracranial Pressure Monitor Placement in Children With Traumatic Brain Injury*

2019 ◽  
Vol 20 (7) ◽  
pp. 645-651 ◽  
Author(s):  
Tellen D. Bennett ◽  
Rebekah Marsh ◽  
Julie A. Maertens ◽  
Alle Rutebemberwa ◽  
Megan A. Morris ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Decision Making ◽  
Brain Injury ◽  
Intracranial Pressure ◽  
Pressure Monitor

Intracranial Pressure Waveform Morphology and Intracranial Adaptive Capacity

2008 ◽  
Vol 17 (6) ◽  
pp. 545-554 ◽  
Author(s):  
Jun-Yu Fan ◽  
Catherine Kirkness ◽  
Paolo Vicini ◽  
Robert Burr ◽  
Pamela Mitchell
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Intracranial Pressure ◽  
Adaptive Capacity ◽  
Severe Traumatic Brain Injury ◽  
Controlled Trial ◽  
Pressure Monitor ◽  
Data Set ◽  
Prime Concern ◽  
Intracranial Pressure Waveform

Background Intracranial hypertension due to primary and secondary injuries is a prime concern when providing care to patients with severe traumatic brain injury. Increases in intracranial pressure vary depending on compensatory processes within the craniospinal space, also referred to as intracranial adaptive capacity. In patients with traumatic brain injury and decreased intracranial adaptive capacity, intracranial pressure increases disproportionately in response to a variety of stimuli. However, no well-validated measures are available in clinical practice to predict the development of such an increase. Objectives To examine whether P2 elevation, quantified by determining the P2:P1 ratio (=0.8) of the intracranial pressure pulse waveform, is a unique predictor of disproportionate increases in intracranial pressure on a beat-by-beat basis in the 30 minutes preceding the elevation in patients with severe traumatic brain injury, within 48 hours after deployment of an intracranial pressure monitor. Methods A total of 38 patients with severe traumatic brain injury were sampled from a randomized controlled trial of cerebral perfusion pressure management in patients with traumatic brain injury or subarachnoid hemorrhage. Results The P2 elevation was not only present before the disproportionate increase in pressure, but also appeared in the comparison data set (within-subject without such a pressure increase). Conclusions P2 elevation is not a reliable clinical indicator to predict an impending disproportionate increase in intracranial pressure.

Statewide Trends in Intracranial Pressure Monitor Use in 36,915 Patients with Severe Traumatic Brain Injury in a Mature Trauma System over the Past 18 Years

2019 ◽  
Vol 130 ◽  
pp. e166-e171 ◽  
Author(s):  
Nikolaos Mouchtouris ◽  
Justin Turpin ◽  
Nohra Chalouhi ◽  
Fadi Al Saiegh ◽  
Thana Theofanis ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Intracranial Pressure ◽  
Severe Traumatic Brain Injury ◽  
Trauma System ◽  
Pressure Monitor ◽  
The Past

An Attitude Survey and Assessment of the Feasibility, Acceptability, and Usability of a Traumatic Brain Injury Decision Support Tool in Uganda

2020 ◽  
Vol 139 ◽  
pp. 495-504
Author(s):  
Cyrus Elahi ◽  
Charis A. Spears ◽  
Sarah Williams ◽  
Timothy W. Dunn ◽  
Josephine N. Najjuma ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Decision Support ◽  
Brain Injury ◽  
Decision Support Tool ◽  
Attitude Survey ◽  
Support Tool

scholarly journals Frequency of and factors associated with emergency department intracranial pressure monitor placement in severe paediatric traumatic brain injury

Brain Injury ◽  
2017 ◽  
Vol 31 (13-14) ◽  
pp. 1745-1752 ◽  
Author(s):  
Nithya Kannan ◽  
Alex Quistberg ◽  
Jin Wang ◽  
Jonathan I. Groner ◽  
Richard B. Mink ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Emergency Department ◽  
Brain Injury ◽  
Intracranial Pressure ◽  
Pressure Monitor ◽  
Factors Associated

scholarly journals Facial Fractures: Independent Prediction of Neurosurgical Intervention

2021 ◽  
Author(s):  
Brandon Lucke-Wold ◽  
Kevin Pierre ◽  
Sina Aghili-Mehrizi ◽  
Gregory Murad
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Intracranial Pressure ◽  
External Ventricular Drain ◽  
Intervention Group ◽  
Facial Fracture ◽  
Pressure Monitor ◽  
Significant Difference ◽  
Neurosurgical Intervention

Abstract Background:Over half of patients with facial fractures have associated traumatic brain injury. Based on previous force dynamic cadaveric studies, Lefort type 2 and 3 fractures are more associated with severe injury. Whether this correlates to neurosurgical intervention have not been well characterized. The purpose of this retrospective data analysis is to characterize fracture pattern types in patients requiring neurosurgical intervention and to see if this is different from those not requiring intervention. Methods:Retrospective data was collected from the trauma registry from 2010-2019. Inclusion criteria: adults over 18, confirmed facial fracture with available neuroimaging, reported traumatic brain injury, and admission to ICU or floor bed. Exclusion criteria: patients less than 18 years old, patients with no neuroimaging, and patients that were deceased prior to initiation of neurosurgical intervention. Data included: basic demographic data, presenting Glasgow Coma Scale (GCS) score, mechanism of injury, type of traumatic brain injury, neurosurgical intervention, and facial fracture type. Retrospective Contingency Analysis with Fraction of Total Comparison was used with Chi-Square analysis for demographic and injury characteristic data.Results:1172 patients met inclusion criteria. 1001 required no neurosurgical intervention and 171 required intervention. No significant difference was seen between the non-intervention group and intervention group in terms of demographic data or baseline injury characteristics except for presenting GCS. A significant difference was seen between groups for presenting Glasgow Coma Scale (c2=67.71, p<0.001). The intervention group had greater number of patients with GCS<8 compared to the non-intervention group. Fracture patterns were overall similar between the non-intervention group compared to intervention group (c2=4.518, p=0.92), however subset analysis did reveal a 2 fold increase in Lefort type 2 fractures and notable increase in Lefort type 3 and panfacial fractures in the intervention group. The intervention group was further divided into those requiring external ventricular drain or intracranial pressure monitor only vs. patients requiring craniectomy, craniotomy, or burr holes with or with external ventricular drain or intracranial pressure monitor. A significant difference was seen between groups (c2=20.02, p=0.03). The craniectomy, craniotomy, or burr hole group was much more likely to have Lefort type 2 or 3 fractures compared to the external ventricular drain or intracranial pressure monitor group only. Conclusions:Lefort type 2 and type 3 fractures are significantly associated with requiring neurosurgical intervention. An improved algorithm for managing these patients has been proposed in the discussion. Ongoing work will focus on validating and refining the algorithm in order to improve patient care for trauma patients with facial fracture and traumatic brain injury.

Intracranial pressure monitor in patients with traumatic brain injury

2015 ◽  
Vol 194 (2) ◽  
pp. 565-570 ◽  
Author(s):  
Andrew Tang ◽  
Viraj Pandit ◽  
Vernard Fennell ◽  
Trevor Jones ◽  
Bellal Joseph ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Intracranial Pressure ◽  
Pressure Monitor

scholarly journals National Variability in Intracranial Pressure Monitoring and Craniotomy for Children With Moderate to Severe Traumatic Brain Injury

Neurosurgery ◽  
2013 ◽  
Vol 73 (5) ◽  
pp. 746-752 ◽  
Author(s):  
William Van Cleve ◽  
Mary A. Kernic ◽  
Richard G. Ellenbogen ◽  
Jin Wang ◽  
Douglas F. Zatzick ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Intracranial Pressure ◽  
Care Delivery ◽  
Pediatric Trauma ◽  
Intracranial Pressure Monitoring ◽  
Trauma Centers ◽  
Older Children ◽  
Pressure Monitoring ◽  
Hospital Variation

Abstract BACKGROUND: Traumatic brain injury (TBI) is a significant cause of mortality and disability in children. Intracranial pressure monitoring (ICPM) and craniotomy/craniectomy (CRANI) may affect outcomes. Sources of variability in the use of these interventions remain incompletely understood. OBJECTIVE: To analyze sources of variability in the use of ICPM and CRANI. METHODS: Retrospective cross-sectional study of patients with moderate/severe pediatric TBI with the use of data submitted to the American College of Surgeons National Trauma Databank. RESULTS: We analyzed data from 7140 children at 156 US hospitals during 7 continuous years. Of the children, 27.4% had ICPM, whereas 11.7% had a CRANI. Infants had lower rates of ICPM and CRANI than older children. A lower rate of ICPM was observed among children hospitalized at combined pediatric/adult trauma centers than among children treated at adult-only trauma centers (relative risk = 0.80; 95% confidence interval 0.66-0.97). For ICPM and CRANI, 18.5% and 11.6%, respectively, of residual model variance was explained by between-hospital variation in care delivery, but almost no correlation was observed between within-hospital tendency toward performing these procedures. CONCLUSION: Infants received less ICPM than older children, and children hospitalized at pediatric trauma centers received less ICPM than children at adult-only trauma centers. In addition, significant between-hospital variability existed in the delivery of ICPM and CRANI to children with moderate-severe TBI.

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