Frequency of and factors associated with emergency department intracranial pressure monitor placement in severe paediatric traumatic brain injury.

The study included only five trauma centers, so it may not represent how other centers make these decisions. The researchers used location as a stand-in for timing and did not have exact monitor placement times, so they could not fully assess why some monitors were placed early. Center 1 was excluded from the emergency department placement analyses because no child there received an emergency department monitor, which limits the range of center practices studied. The study was a retrospective chart review, so it could not measure physician preferences or other center culture factors that may affect placement. Children who died within the first 48 hours of admission were excluded from the parent study, which may have changed the associations found. The study was not powered or designed to test whether emergency department monitoring affects mortality or functional outcome, so the null outcome findings are not proof of no effect. Emergency department length of stay and monitor placement may influence each other, so the association does not show cause and effect.

Do not conclude that placing an intracranial pressure monitor in the emergency department improves survival or functional outcome. The study was not powered or designed to test that question, and it reported no difference in in-hospital mortality or discharge Glasgow Outcome Scale between emergency department placement and later operating room or intensive care unit placement.