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Identifying Clinical Predictors of Raised Intracranial Pressure in Pediatric Traumatic Brain Injury-A Multinational

Noah Xin Ying Yeo1, Hui Jun Zhou2, Jan Hau Lee3,4

  • 1Duke-NUS Medical School, Singapore, Singapore.

Neurotrauma Reports
|October 20, 2025
PubMed

Insights

Intracranial pressure monitoring in pediatric traumatic brain injury is inconsistent. A new prediction model showed limited sensitivity for identifying elevated intracranial pressure in children with TBI.

Area of Science:

  • Pediatric critical care medicine
  • Neurotrauma research
  • Clinical prediction modeling

Background:

  • Intracranial pressure (ICP) monitoring use varies in pediatric traumatic brain injury (TBI).
  • Clinical prediction models for raised ICP exist for adults but lack validation in pediatric TBI.
  • Identifying predictors for raised ICP is crucial for managing pediatric TBI.

Purpose of the Study:

  • To investigate clinical predictors of raised ICP in pediatric TBI.
  • To derive and validate a clinical prediction model for raised ICP in pediatric TBI patients.

Main Methods:

  • A real-world observational study across international pediatric intensive care units.
  • Included children (<18 years) with moderate-to-severe TBI (2014-2022).
  • Defined raised ICP as >20 mmHg; used multivariable logistic regression and AUC for model assessment.

Main Results:

  • Only 21.4% of 706 pediatric TBI patients received ICP monitoring; 49.7% of those monitored had raised ICP.
  • Mortality was higher in non-monitored patients (13.2%) compared to those with raised ICP (8.0%) or normal ICP (4.0%).
  • The derived prediction model (sex, GCS motor score, leukocytosis, thrombocytopenia, skull fracture) had 56.0% sensitivity and 73.7% AUC for raised ICP.

Conclusions:

  • Clinical predictors for raised ICP in pediatric TBI were identified.
  • The developed prediction model demonstrated limited sensitivity for detecting raised ICP.
  • Future research should focus on large-scale prospective studies stratifying predictors by intracranial pathologies.

Keywords:
childclinical predictorsmonitoringraised intracranial pressuretraumatic brain injury

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