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Development of a Randomized Trial Comparing ICP-Monitor-Based Management of Severe Pediatric Traumatic Brain Injury to Management Based on Imaging and Clinical Examination Without ICP Monitoring-Study Protocol.
- Source :
-
Neurosurgery [Neurosurgery] 2024 Jan 01; Vol. 94 (1), pp. 65-71. Date of Electronic Publication: 2023 Jul 06. - Publication Year :
- 2024
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Abstract
- Background and Objectives: Traumatic brain injury (TBI) is a major global public health problem. It is a leading cause of death and disability in children and adolescents worldwide. Although increased intracranial pressure (ICP) is common and associated with death and poor outcome after pediatric TBI, the efficacy of current ICP-based management remains controversial. We intend to provide Class I evidence testing the efficacy of a protocol based on current ICP monitor-based management vs care based on imaging and clinical examination without ICP monitoring in pediatric severe TBI.<br />Methods: A phase III, multicenter, parallel-group, randomized superiority trial performed in intensive care units in Central and South America to determine the impact on 6-month outcome of children aged 1-12 years with severe TBI (age-appropriate Glasgow Coma Scale score ≤8) randomized to ICP-based or non-ICP-based management.<br />Expected Outcomes: Primary outcome is 6-month Pediatric Quality of Life. Secondary outcomes are 3-month Pediatric Quality of Life, mortality, 3-month and 6-month Pediatric extended Glasgow Outcome Score, intensive care unit length of stay, and number of interventions focused on treating measured or suspected intracranial hypertension.<br />Discussion: This is not a study of the value of knowing the ICP in sTBI. This research question is protocol-based. We are investigating the added value of protocolized ICP management to treatment based on imaging and clinical examination in the global population of severe pediatric TBI. Demonstrating efficacy should standardize ICP monitoring in severe pediatric TBI. Alternate results should prompt reassessment of how and in which patients ICP data should be applied in neurotrauma care.<br /> (Copyright © Congress of Neurological Surgeons 2023. All rights reserved.)
- Subjects :
- Adolescent
Humans
Child
Intracranial Pressure
Quality of Life
Glasgow Coma Scale
Monitoring, Physiologic methods
Randomized Controlled Trials as Topic
Multicenter Studies as Topic
Brain Injuries, Traumatic diagnostic imaging
Brain Injuries, Traumatic therapy
Brain Injuries
Intracranial Hypertension diagnostic imaging
Intracranial Hypertension etiology
Subjects
Details
- Language :
- English
- ISSN :
- 1524-4040
- Volume :
- 94
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- Neurosurgery
- Publication Type :
- Academic Journal
- Accession number :
- 37409817
- Full Text :
- https://doi.org/10.1227/neu.0000000000002582