title: Monitoring and prediction of intracranial hypertension in pediatric traumatic brain injury: clinical factors and initial head computed tomography.
abstract: BACKGROUND
  Control of intracranial hypertension (ICH) in patients with traumatic brain injury (TBI) is standard care. However, predicting risk for ICH is essential to balance risks and benefits of intracranial pressure (ICP) monitoring. Current recommendations for ICP monitoring in pediatric trauma patients are extrapolated from adult studies.
  
  
  METHODS
  This retrospective study evaluated 299 children admitted to Primary Children's Medical Center with moderate to severe TBI. ICP monitors were used in 120. Demographic, injury, and admission computed tomography (CT) scan characteristics were compared with determine factors associated with monitoring among those with less severe head CT findings. Among all monitored patients, clinical and radiographic features were compared for early ICH defined as any sustained ICP ≥20 mm Hg in the first 24 hours.
  
  
  RESULTS
  Factors independently associated with monitoring children with Marshall I or II scores included presence of intraventricular hemorrhage (odds ratio [OR], 21.4; 95% confidence interval [CI], 4.0-114.7) and greater injury severity scores (ISS) (OR, 9.5 [95% CI, 2.9-31.1] for ISS 21 to 29 and OR, 14.3 [95% CI, 4.3-50.5] for ISS >29 compared with ISS <21). Among those with a normal head CT, 9 of 68 had an ICP monitor placed because of the inability to localize pain. Of these, 78% (7 of 9) had early ICH. Among monitored patients radiologic and clinical features of injury severity were not useful to distinguish risk for early ICH.
  
  
  CONCLUSIONS
  Among children with severe TBI, a normal head CT does not exclude ICH. Need for ICP monitoring should be determined by depth of coma in addition to radiographic imaging.
authors.affiliation: University of Utah School of Medicine, Kaysville, Utah, USA.
authors.forename: Beau M
authors.initials: BM
authors.lastname: Bailey
authors.forename: Kate
authors.initials: K
authors.lastname: Liesemer
authors.forename: Kimberly D
authors.initials: KD
authors.lastname: Statler
authors.forename: Jay
authors.initials: J
authors.lastname: Riva-Cambrin
authors.forename: Susan L
authors.initials: SL
authors.lastname: Bratton
mesh_terms: D001930:Brain Injuries / Q000150:complications* / Q000000981:diagnostic imaging; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D015601:Injury Severity Score; D019586:Intracranial Hypertension / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000209:etiology*; D007427:Intracranial Pressure; D008297:Male; D008991:Monitoring, Physiologic; D012189:Retrospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D014193:Trauma Centers / Q000706:statistics & numerical data