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Hemorrhagic complications of intracranial pressure monitors in children

Martin Blaha1, Daniel Lazar, Richard H Winn

  • 1Department of Neurological Surgery, University of Washington School of Medicine and Children's Hospital and Medical Center, Seattle 98105, USA.

Pediatric Neurosurgery
|June 5, 2003
PubMed

Insights

Hemorrhage after intracranial pressure (ICP) monitoring in children is uncommon, with most cases being clinically silent. A new grading system was proposed, highlighting the importance of neuroradiological studies for accurate complication assessment.

Area of Science:

  • Pediatric Neurosurgery
  • Neurocritical Care
  • Medical Device Complications

Background:

  • Intracranial pressure (ICP) monitoring is crucial for managing pediatric head injuries and elevated ICP.
  • Assessing complications like hemorrhage post-ICP monitor insertion is vital for patient safety.

Purpose of the Study:

  • To determine the incidence of hemorrhage following ICP monitor insertion in pediatric patients.
  • To classify these hemorrhagic complications using a novel, clinically relevant grading system.

Main Methods:

  • Retrospective review of hospital charts for 431 children (ages 0-16) at a level I trauma center over 2 years.
  • Identification of 112 patients (134 insertions) who underwent intraparenchymal ICP monitoring.
  • Analysis of postoperative neuroradiological studies to detect and grade hemorrhages.

Main Results:

  • A complication rate of approximately 10% was observed.
  • 119 insertions (grade 0) had no hemorrhage.
  • 10 insertions (grade 1) showed minor hemorrhage (punctate or subarachnoid); 3 insertions (grade 2) had intracerebral hemorrhage without new deficits or need for evacuation.
  • No grade 3 hemorrhages requiring intervention or causing clinical change were found.

Conclusions:

  • A new grading system for post-ICP monitor insertion hemorrhage is proposed.
  • While most hemorrhages in pediatric patients were clinically silent and required no intervention, they may lead to false ICP readings.
  • The long-term effects of these hemorrhages remain unknown, and underreporting in patient charts (23% documented) may skew reported complication rates.

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