Chapter 3. Indications for intracranial pressure monitoring

Four lines of evidence support the use of ICP monitoring in children with severe TBI: a frequently reported high incidence of intracranial hypertension in children with severe TBI, a widely reported association of intracranial hypertension and poor neurologic outcome, the concordance of protocol-based intracranial hypertension therapy and best-reported clinical outcomes, and improved outcomes associated with successful ICP-lowering therapies. Evidence reviewed in the adult guidelines mirrors that for pediatric patients, further suggesting that ICP monitoring is of clinical benefit in patients with severe TBI. Intracranial hypertension is both difficult to diagnose and is associated with poor neurologic outcomes and death in infants and young children. Intracranial hypertension may be present in children with open fontanelles and sutures (18). ICP monitoring is of significant use in these patient populations. The presence of intracranial hypertension can also be influenced by the type of pathology on CT such as diffuse injury or specific etiologies such as traumatic sinus thrombosis. By contrast, ICP monitoring is not routinely indicated in children with mild or moderate TBI. Treating physicians may, however, in some circumstances, choose to use ICP monitoring in conscious children who are at relative risk for neurologic deterioration as a result of the presence of traumatic mass lesions or in whom serial neurologic examination is precluded by sedation, neuromuscular blockade, or anesthesia. © 2012 Brain Trauma Foundation.