Table 3: Bivariate Analyses of Factors Associated with Emergency Department (ED) Intracranial Pressure (ICP) Monitor Placement (N=65) Among the Four Trauma Centers (Centers 2–5) That Placed ICP monitor in the ED (Total N = 123).
OR = Operating Room. PICU = Pediatric Intensive Care Unit.
| Factors | OR or PICU ICP monitor placement N = 58 (33%; 58/177) N (%) | ED ICP monitor placement N = 65 (37%; 65/177) N (%) | Crude RR (95% CI)* of ED ICP monitor placement |
|---|---|---|---|
| Age (years) | |||
| < 1y | 9 (16) | 5 (8) | 1 [Reference] |
| 1 to < 5y | 14 (24) | 14 (22) | 1.43 (0.70, 2.95) |
| 5 to <13y | 13 (22) | 12 (18) | 1.41 (0.99, 2.02) |
| 13 to <18y | 22 (38) | 34 (52) | 1.75 (1.41, 2.18) |
| Head abbreviated injury severity score | |||
| 3 or 4 | 19 (33) | 22 (34) | 1 [Reference] |
| 5 or 6 | 39 (67) | 43 (66) | 0.99 (0.78, 1.26) |
| Injury severity score | |||
| <15 | 4 (7) | 3 (5) | 1 [Reference] |
| ≥15 | 54 (93) | 62 (95) | 1.32 (0.47, 3.68) |
| Inflicted injury | 10 (17) | 8 (12) | 0.79 (0.58, 1.08) |
| Direct admit | 43 (74) | 44 (68) | 0.88 (0.52, 1.49) |
| Head CT findings | |||
| Epidural or subdural hematoma or subarachnoid hemorrhage | 52 (90) | 56 (86) | 0.88 (0.57, 1.34) |
| Intracerebral hemorrhage | 18 (31) | 27 (42) | 1.28 (0.89, 1.84) |
| Intraventricular hemorrhage | 11 (19) | 18 (28) | 1.24 (0.96, 1.60) |
| Contusion | 24 (41) | 26 (40) | 1.00 (0.87, 1.15) |
| Prehospital (PH) hypotension only (ED ICP monitor placement n = 56; OR or PICU ICP monitor placement n = 57) | 9 (16) | 10 (18) | 0.98 (0.86, 1.11) |
| ED hypotension only | 5 (9) | 10 (15) | 1.29 (1.02, 1.64) |
| PH or ED hypotension | 12 (21) | 16 (25) | 1.09 (0.94, 1.25) |
|
Decompressive craniectomy (ED ICP monitor placement n = 35; OR or PICU ICP monitor placement n = 29) |
22 (76) | 24 (69) | 0.85 (0.43, 1.70) |
| ED Length of stay (LOS) median (IQR) hours | 1.5 (1.2, 2.5) | 2.5 (1.3, 5.8) | 1.12 (1.05, 1.20) |
| Trauma center designation | |||
| Adult and pediatric I/II | 46 (79) | 37 (57) | 1 [Reference] |
| Pediatric only I/II | 12 (21) | 28 (43) | 1.57 (1.08, 2.29) |
| Mean pediatric TBI patient volume per center≠ | |||
| < 200 | 28 (48) | 15 (23) | 1 [Reference] |
| ≥ 200 | 30 (52) | 50 (77) | 1.79 (1.52, 2.11) |
| Total number of bedside ED staff | |||
| < 8 | 10 (17) | 20 (31) | 1 [Reference] |
| ≥ 8 | 48 (83) | 45 (69) | 0.73 (0.51, 1.04) |
| Neurosurgery resident present in ED | 20 (34) | 30 (46) | 1.25 (0.71, 2.20) |
*
Crude RR is relative risk with 95% confidence interval for factors associated with ED ICP monitor placement
Inflicted injury, direct admit, head CT findings, PH hypotension only, ED hypotension only, PH or ED hypotension, decompressive craniectomy are dichotomous variables (Yes/No) with Reference group = No