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Intracranial Pressure Control Essential in Pediatric TBI

Retrospective review finds that control predicts survival from traumatic brain injuries

FRIDAY, Oct. 17 (HealthDay News) -- In the management of severe pediatric traumatic brain injury (TBI), controlling elevated intracranial pressure is an important factor in patient survival, according to an article published in the October issue of the Journal of Neurosurgery: Pediatrics.

Jay Jagannathan, M.D., of the University of Virginia Health System in Charlottesville, and colleagues studied outcomes in 96 patients aged 3 to 18 with a Glasgow Coma Scale score of less than 8, an elevated intracranial pressure above 20 mm Hg, and a mean injury severity score of 65.

The researchers found that intracranial pressure control was achieved in 82 patients (85 percent), and that the successful methods included maximal medical therapy, ventriculostomy and surgery. Despite maximal medical and surgical management, intracranial pressure control was not achieved in 14 of the patients (15 percent), all of whom died. After a mean follow-up of 53 months, the investigators found that the remaining 69 survivors had a mean Glasgow Outcome Scale score of 4 and a mean patient competency rating of 4.13 out of 5.

"Our study demonstrates that medical therapy can be highly effective when used initially in the management of elevated intracranial pressure in select pediatric patients with head injury; more than one-third of all patients in this series achieved and maintained normalization of intracranial pressure using medical management alone," the authors write. "The fact that the neurocognitive outcomes were higher in this group of patients is likely related to the fact that the majority of patients who had unsuccessful medical management of their intracranial pressure had a more severe brain injury (radiographically and pathophysiologically)."

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