Age-related differences in intracranial pressure and cerebral perfusion pressure in the first 6 hours of monitoring after children's head injury: association with outcome.
OBJECTIVE
Severe head injury in childhood is associated with considerable mortality and morbidity. In this study we determined age-related differences in the relationship between outcome and intracranial pressure (ICP) and cerebral perfusion pressure (CPP) in the first 6 h of monitoring in a large cohort of head-injured children.


METHODS
Two hundred and thirty-five head-injured children (admitted to five UK hospitals over a 15-year period) in whom intracranial pressure monitoring was clinically indicated were studied.


RESULTS
Patients were divided into three age groups (2-6, 7-10 and 11-16 years). The sensitivity of ICP and CPP were similar. Differences were found in the specificity of ICP and CPP for each group and these were more marked for CPP. For a specificity of 50% the pressures were 53, 63 and 66 mmHg for the three age groups.


CONCLUSIONS
There are age-related differences in the specificity of intracranial pressure and cerebral perfusion pressure in relation to outcome. These differences may be important in the clinical management of head-injured children. Thus cerebral perfusion pressures of 53, 63 and 66 mmHg should be the minimum to strive for in these three age groups respectively.
Chambers
I R
IR
Regional Medical Physics Department, Newcastle General Hospital, Newcastle upon Tyne, NE4 6BE, UK. i.r.chambers@ncl.ac.uk
Stobbart
L
L
Jones
P A
PA
Kirkham
F J
FJ
Marsh
M
M
Mendelow
A D
AD
Minns
R A
RA
Struthers
S
S
Tasker
R C
RC
D000293:Adolescent; D000375:Aging / Q000502:physiology*; D001794:Blood Pressure; D002560:Cerebrovascular Circulation / Q000502:physiology*; D002648:Child; D002675:Child, Preschool; D006259:Craniocerebral Trauma / Q000503:physiopathology*; D005260:Female; D015600:Glasgow Coma Scale / Q000706:statistics & numerical data; D006801:Humans; D007427:Intracranial Pressure / Q000502:physiology*; D008297:Male; D008991:Monitoring, Physiologic / Q000379:methods*; D012680:Sensitivity and Specificity