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

Darryl K. Miles, Maria R. Ponisio, Ryan Colvin, David Limbrick, Jacob K. Greenberg, Celeste Brancato, Jeffrey R. Leonard, Jose A. Pineda

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)1453-1460
Number of pages8
JournalChild's Nervous System
Volume36
Issue number7
DOIs
StatePublished - Jul 1 2020

Keywords

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

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Clinical Neurology

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    Miles, D. K., Ponisio, M. R., Colvin, R., Limbrick, D., Greenberg, J. K., Brancato, C., Leonard, J. R., & Pineda, J. A. (2020). Predictors of intracranial hypertension in children undergoing ICP monitoring after severe traumatic brain injury. Child's Nervous System, 36(7), 1453-1460. https://doi.org/10.1007/s00381-020-04516-7