Document Detail


Intracranial pressure monitoring in childhood meningitis with coma: A national survey of neurosurgeons in the United States.
MedLine Citation:
PMID:  21263366     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
OBJECTIVES:: To describe the beliefs and attitudes of U.S. neurosurgeons regarding the use of intracranial pressure monitors among comatose children with meningitis. DESIGN AND SETTING:: A questionnaire was administered by mail between March and July 2009, to a random sample of 500 adult neurosurgeons and to all 228 pediatric neurosurgeons in the Congress of Neurologic Surgeons. INTERVENTIONS:: None. MEASUREMENTS AND MAIN RESULTS:: The response rate was 60%. Abnormal computed tomography scans, either with brain swelling or hydrocephalus, and older child age were likely to prompt neurosurgeons to consider monitoring intracranial pressure, whereas etiology of meningitis did not impact the decision to monitor intracranial pressure. Fifty-two percent of neurosurgeons believed computed tomography scans were inaccurate in detecting elevated intracranial pressure in comatose children with meningitis, 22% believed otherwise, and 26% were uncertain. Only 25% of neurosurgeons felt there was sufficient medical evidence to monitor intracranial pressure in comatose children with meningitis, with higher frequency among adult than pediatric (30% vs. 16%; p < .01) neurosurgeons. Eighty-one percent of neurosurgeons disagreed with the notion that comatose children with meningitis were too ill to benefit from placement of intracranial pressure monitors. Pediatric neurosurgeons reported a higher frequency than adult neurosurgeons of having placed more (more than five) intracranial pressure monitors in comatose children with meningitis (42% vs. 28%; p < .01). CONCLUSIONS:: Most neurosurgeons are willing to consider monitoring intracranial pressure among comatose children with meningitis in the presence of abnormal findings on computed tomography scan and with older patient age. These findings are instructive in view of the current uncertainty and equipoise in clinical practice regarding intracranial pressure monitoring in these critically ill children.
Authors:
Folafoluwa O Odetola; Sarah J Clark; Kara E Lamarand; Matthew M Davis; Hugh J Garton
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-1-21
Journal Detail:
Title:  Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies     Volume:  -     ISSN:  1529-7535     ISO Abbreviation:  -     Publication Date:  2011 Jan 
Date Detail:
Created Date:  2011-1-25     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100954653     Medline TA:  Pediatr Crit Care Med     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
From the Department of Pediatrics and Communicable Diseases, Division of Pediatric Critical Care Medicine (FOO), Department of Pediatrics and Communicable Diseases, Child Health Evaluation and Research Unit (FOO, SJC, KEL, MMD), Division of General Internal Medicine (MMD), and the Gerald R. Ford School of Public Policy, University of Michigan, Ann Arbor, MI; Department of Neurosurgery (HJG), University of Michigan Health System, Ann Arbor, MI.
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