Thresholds for identifying pathological intracranial pressure in paediatric traumatic brain injury.
Ewen, Ross L
Guilfoyle, Mathew R
Fernandes, Helen M
Nature Publishing Group
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Kayhanian, S., Young, A., Ewen, R. L., Piper, R. J., Guilfoyle, M. R., Donnelly, J., Fernandes, H. M., et al. (2019). Thresholds for identifying pathological intracranial pressure in paediatric traumatic brain injury.. Scientific reports, 9 (1), 3537. https://doi.org/10.1038/s41598-019-39848-1
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 (20mmHg) 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.
Humans, Tomography, X-Ray Computed, Retrospective Studies, Intracranial Pressure, Adolescent, Child, Child, Preschool, Female, Male, Brain Injuries, Traumatic
We gratefully acknowledge financial support as follows. Research support: the Medical Research Council (MRC, Grant Nos. G0600986 ID79068 and G1002277 ID98489) and the National Institute for Health Research Biomedical Research Centre (NIHR BRC) Cambridge (Neuroscience Theme; Brain Injury and Repair Theme). Authors’ support: Peter J Hutchinson – NIHR Research Professorship, Academy of Medical Sciences/Health Foundation Senior Surgical Scientist Fellowship, NIHR Global Health Research Group on Neurotrauma, and NIHR Cambridge BRC. Joseph Donnelly is supported by a Woolf Fisher Scholarship. MC- NIHR BRC.
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External DOI: https://doi.org/10.1038/s41598-019-39848-1
This record's URL: https://www.repository.cam.ac.uk/handle/1810/288861