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A clinical evaluation of variation in paediatric intracranial pressure waveforms
Amarah Saeed1, Richard Boulton2, Roddy O'Kane3
1School of Medicine, University of Glasgow, Scotland, United Kingdom.
Insights
High-amplitude intracranial pressure (ICP) spikes in children aged 0-5 years are more common in younger patients. Further research is needed to understand the clinical impact of these ICP spikes.
Area of Science:
- Pediatric Neurology
- Intracranial Pressure Monitoring
Background:
- Intracranial pressure (ICP) monitoring is crucial for diagnosing chronic pediatric neurological conditions.
- High-amplitude ICP spikes have been noted in overnight recordings, particularly in children with hydrocephalus or craniosynostosis.
Purpose of the Study:
- To define the specific pattern of high-amplitude ICP spikes.
- To identify patient demographics associated with these spikes.
- To perform high-resolution waveform analysis of ICP.
Main Methods:
- Retrospective analysis of ICP waveforms from 40 pediatric patients (0-5 years).
- Visual inspection by two reviewers to define the spike pattern.
- Statistical analysis using R software, including adjusted Poisson regression.
Main Results:
- The spike pattern was defined as two consecutive spikes ≥8 mmHg with a ≥30 min gap.
- Younger age was significantly associated with a higher number of ICP spikes (IRR 0.8, p=0.001).
Conclusions:
- Younger children in this cohort exhibited a higher frequency of high-amplitude ICP spikes.
- Further investigation into the clinical implications of these ICP spikes is recommended.
Introduction:
Intracranial pressure (ICP) monitoring is commonly used in investigating the aetiology of chronic paediatric neurological conditions. A series of high-amplitude spikes has been observed in overnight ICP recordings of some children, many of whom have hydrocephalus or craniosynostosis.
Research Question:
This clinical evaluation aimed to define the spike pattern, describe the patient group in which it is most likely to occur, and conduct high-resolution waveform analysis.
Material And Methods:
ICP waveforms from 40 patients aged 0-5 years (inclusive), recorded between 2017 and 2021 at the Royal Hospital for Children Glasgow, were retrospectively analysed. The pattern was defined through visual inspection of regions of interest by two reviewers. Patients were stratified using demographic and clinical data. R software was used to perform regression and high-resolution waveform analyses.
Results:
The spike pattern was defined as the presence of 2 consecutive spikes with an amplitude of at least 8 mmHg, with a gap of at least 30 min between spikes. In the adjusted Poisson regression, age was significantly associated with the number of spikes (IRR 0.8, 95% CI 0.70 to 0.92, p-value 0.001).
Discussion And Conclusion:
Younger age was significantly associated with an increased number of spikes in this cohort. Investigation of clinical consequences of the spikes is warranted.
