• William Van Cleve, Mary A Kernic, Richard G Ellenbogen, Jin Wang, Douglas F Zatzick, Michael J Bell, Mark S Wainwright, Jonathan I Groner, Richard B Mink, Christopher C Giza, Linda Ng Boyle, Pamela H Mitchell, Frederick P Rivara, Monica S Vavilala, and PEGASUS (Pediatric Guideline Adherence and Outcomes) Project.
• *Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, Washington; ‡Department of Epidemiology, University of Washington, Seattle, Washington; §Departments of Neurological Surgery and Global Health Medicine, University of Washington, Seattle, Washington; ¶Harborview Injury Prevention and Research Center, Seattle, Washington; ‖Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington; #Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania; **Department of Pediatrics, Northwestern University, Chicago, Illinois; ‡‡Department of Surgery, Ohio State University College of Medicine, Columbus, Ohio; §§Harbor-UCLA Medical Center, Los Angeles BioMedical Research Institute and David Geffen School of Medicine at UCLA, Los Angeles, California; ¶¶Divisions of Neurosurgery and Pediatric Neurology, UCLA, Los Angeles, California; ‖‖College of Engineering, University of Washington, Seattle, Washington; ##School of Nursing, University of Washington, Seattle, Washington.
• Neurosurgery. 2013 Nov 1;73(5):746-52; discussion 752; quiz 752.

BackgroundTraumatic 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.ObjectiveTo analyze sources of variability in the use of ICPM and CRANI.MethodsRetrospective 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.ResultsWe 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.ConclusionInfants 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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