Predictors of intracranial hypertension in children undergoing ICP monitoring after severe traumatic brain injury

Abstract

Purpose

Intracranial hypertension (ICH) is a common and treatable complication after severe traumatic brain injury (sTBI) in children. Describing the incidence and risk factors for developing ICH after sTBI could impact clinical practice.

Methods

Retrospective cohort study from 2006 to 2015 at two university-affiliated level I pediatric trauma centers of children admitted with accidental or abusive TBI, a post-resuscitation Glasgow Coma Score (GCS) of 8 or less, and an invasive intracranial pressure (ICP) monitor. Bivariate and multivariable logistic regression analysis were performed to identify demographic, injury, and imaging characteristics in patients who received ICP directed therapies for ICH (ICP > 20 mmHg).

Results

Eight to 5% (271/321) of monitored patients received ICP directed therapy for ICH during their PICU stay. Ninety-seven percent of patients had an abnormality on CT scan by either the Marshall or the Rotterdam score. Of the analyzed clinical and radiologic variables, only presence of hypoxia prior to PICU arrival, female sex, and a higher Injury Severity Score (ISS) were associated with increased risk of ICH (p < 0.05).

Conclusions

In this retrospective study of clinical practice of ICP monitoring in children after sTBI, the vast majority of children had an abnormal CT scan and experienced ICH requiring clinical intervention. Commonly measured clinical variables and radiologic classification scores did not significantly add to the prediction for developing of ICH and further efforts are needed to define low-risk populations that would not develop ICH.

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Acknowledgments

Cynthia Greenwell at Children’s Medical Center Dallas and Tina Day and Lori Barganier at Washington University contributed to data collection.

Funding

This study was supported by the St. Louis Children’s Hospital Foundation, the Sean Glanvill Foundation, the Robert Wood Johnson Foundation Harold Amos Medical Faculty Development Program (JAP), and The Perot Brain and Nerve Injury Center (DKM).

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Correspondence to Darryl K. Miles.

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Miles, D.K., Ponisio, M.R., Colvin, R. et al. Predictors of intracranial hypertension in children undergoing ICP monitoring after severe traumatic brain injury. Childs Nerv Syst 36, 1453–1460 (2020). https://doi.org/10.1007/s00381-020-04516-7

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Keywords

  • Traumatic brain injury
  • Pediatric
  • Intracranial hypertension
  • CT imaging