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Editorial
October 2017

Big Data Not Yet Big Enough to Determine the Influence of Intracranial Pressure Monitoring on Outcome in Children With Severe Traumatic Brain Injury

Author Affiliations
  • 1Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
  • 2Children’s Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
JAMA Pediatr. 2017;171(10):942-943. doi:10.1001/jamapediatrics.2017.2390

Care of patients with severe traumatic brain injury (TBI) has improved over time. Between 2001 and 2010, the Centers for Disease Control and Prevention noted that deaths from severe TBI declined from 18.5 to 17.1 per 100 000 people.1 Review of a state database demonstrated a reduction in the rate of fatalities from severe TBI during a comparable period.2 However, such improvements cannot be attributed to any single breakthrough therapy. Recent years have brought a number of well-conducted trials with negative results in adults and children with severe TBI, highlighting the intrinsic difficulties in conducting clinical research related to this disease.35 The most recent iteration of the guidelines for the management of severe TBI in children synthesized the literature across 15 management topics, providing recommendations according to the strength of available evidence.6 Level I recommendations referred to management components that must be done, level II recommendations to components that should be done, and level III recommendations to components that may be considered. Insufficient or conflicting evidence existed for many of the evaluated therapies, such that no level I and only 4 level II recommendations were offered. A level III recommendation was made for monitoring intracranial pressure (ICP), citing 2 moderate-quality and 14 low-quality studies that together suggest a potential benefit but a need for further evaluation.

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