Abstract
Intracranial pressure (ICP) monitoring forms an integral part of the management of severe traumatic brain injury (TBI) in children. The prediction of elevated ICP from imaging is important when deciding on whether to implement invasive ICP monitoring for a patient. However, the radiological markers of pathologically elevated ICP have not been specifically validated in paediatric studies. Here in, we describe an objective, non-invasive, quantitative method of stratifying which patients are likely to require invasive monitoring. A retrospective review of patients admitted to Cambridge University Hospital’s Paediatric Intensive Care Unit between January 2009 and December 2016 with a TBI requiring invasive neurosurgical monitoring was performed. Radiological biomarkers of TBI (basal cistern volume, ventricular volume, volume of extra-axial haematomas) from CT scans were measured and correlated with epochs of continuous high frequency variables of pressure monitoring around the time of imaging. 38 patients were identified. Basal cistern volume was found to correlate significantly with opening ICP (r = −0.53, p < 0.001). The optimal threshold of basal cistern volume for predicting high ICP (ge 20 mmHg) was a relative volume of 0.0055 (sensitivity 79%, specificity 80%). Ventricular volume and extra-axial haematoma volume did not correlate significantly with opening ICP. Our results show that the features of pathologically elevated ICP in children may differ considerably from those validated in adults. The development of quantitative parameters can help to predict which patients would most benefit from invasive neurosurgical monitoring and we present a novel radiological threshold for this.
Highlights
Traumatic brain injury (TBI) remains a major cause of death and morbidity worldwide[1]
Be desirable to develop quantified predictive parameters, which could be consistently applied, to identify the cohort of paediatric patients who are most at risk of elevated Intracranial pressure (ICP). In this retrospective analysis of children with traumatic brain injury (TBI), we report the correlations between the features of referred computerized tomography (CT) scans with the opening ICP at the time of surgery
All ICP monitors were inserted after a clinical examination determined poor neurology (GCS < M5), requiring intensive medical management
Summary
Traumatic brain injury (TBI) remains a major cause of death and morbidity worldwide[1]. Radiological features that correlate elevated ICP (e.g. midline shift, basal cistern, and sulcal effacement) have been studied in adults and correlated to long-term outcomes, as demonstrated by Rotterdam and Marshall scoring systems[7,8] These features have not been well validated in paediatric cohorts and there is increasing recognition that there may be clinically significant differences between adult and paediatric CT-head features of raised ICP. Www.nature.com/scientificreports shown to differ significantly between adults and paediatric cohorts with the same Glasgow Coma Score (GCS) after TBI11 These reported differences in radiological features may be explained by the known differences in anatomy, biomechanics and pathophysiology of paediatric head injury versus that in adults. Be desirable to develop quantified predictive parameters, which could be consistently applied, to identify the cohort of paediatric patients who are most at risk of elevated ICP
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
