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

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.