Related Experiment Video
Updated: Jun 21, 2026
14:08
Automated Midline Shift and Intracranial Pressure Estimation based on Brain CT Images
Published on: April 13, 2013
43.8K
Intracranial Pressure Treatment Thresholds in Pediatric Traumatic Brain Injury.
Shruti Agrawal1,2, Stefan Y Bögli3,4, Roddy O'Donnell2
1Department of Paediatrics, University of Cambridge, Cambridge, United Kingdom.
JAMA Pediatrics
|April 6, 2026
Summary
Intracranial pressure (ICP) management in pediatric traumatic brain injury (pTBI) may benefit from lower thresholds. Sustained ICP above 14-15 mm Hg is linked to poorer outcomes, suggesting current guidelines may be too high.
Area of Science:
- Pediatric Intensive Care
- Neurotrauma
- Clinical Outcomes Research
Background:
- Intracranial pressure (ICP) management is crucial for improving outcomes in pediatric traumatic brain injury (pTBI).
- Current ICP treatment thresholds lack robust pediatric-specific evidence.
- Evidence suggests existing thresholds may not be optimal for pediatric populations.
Purpose of the Study:
- To investigate ICP thresholds associated with functional outcomes in pediatric traumatic brain injury.
- To determine optimal ICP management targets for children with pTBI.
- To evaluate the relationship between ICP levels and long-term functional recovery in pediatric patients.
Main Methods:
- Secondary analysis of the prospective, multicenter STARSHIP database (n=135).
- Inclusion of children (≤16 years) with invasive ICP monitoring for pTBI.
- Analysis of minute-level ICP data, exploring thresholds from 5 to 20 mm Hg using static and dynamic models, with sensitivity analyses including propensity score matching and causal modeling.
Main Results:
- Mean ICP was significantly higher in patients with poor outcomes (44 mm Hg vs. 17 mm Hg).
- ICP thresholds of 14-15 mm Hg were most discriminatory for outcome.
- Elevated ICP (>14-15 mm Hg) was associated with increased odds of poor functional outcome (OR 6.1, P<.001).
- Sustained ICP >15 mm Hg predicted poor 12-month functional outcomes, confirmed by advanced statistical modeling.
Conclusions:
- Sustained intracranial pressure elevations above 14-15 mm Hg are linked to poor long-term functional outcomes in pediatric traumatic brain injury.
- Findings suggest current ICP treatment thresholds (e.g., 20 mm Hg) may be too high for pediatric patients.
- Prospective evaluation of lower ICP thresholds is warranted for optimizing pTBI management.
Related Concept Videos
01:28Traumatic Brain Injury l: Introduction
DefinitionTraumatic brain injury, or TBI, is a disturbance of normal brain function induced by an external mechanical force, such as a direct blow to the head or a penetrating injury. It can affect both brain structure and function, producing a wide range of clinical outcomes. TBI is a heterogeneous condition, meaning its effects may differ based on the type, location, and severity of the injury.Basis of ClassificationTBI is classified based on severity, injury mechanism, or pathophysiology. In...
01:14Increased Intracranial Pressure l: Introduction
Intracranial hypertension is a sustained elevation of intracranial pressure (ICP) above 22 mm Hg. In supine adults, normal ICP is ~7–15 mm Hg.The rigid, nonexpandable cranium contains three components—brain tissue, blood, and cerebrospinal fluid (CSF)—that total ~1,700 mL in a typical adult: 1,400 mL brain (~80%), 150 mL blood (~10%), and 150 mL CSF (~10%). According to the Monro–Kellie doctrine, total intracranial volume is effectively fixed. When one component expands, CSF and venous blood...
01:29Increased Intracranial Pressure ll: Pathophysiology
Increased intracranial pressure (ICP) refers to a potentially life-threatening rise in pressure inside the skull. This usually happens when there is a major change in the volume of brain tissue, blood, or cerebrospinal fluid (CSF) — the three components inside the skull. According to the Monro-Kellie doctrine, if the volume of one component increases, the volumes of the other components must decrease to maintain normal pressure. If this does not happen, ICP rises.The process often begins with...
01:22Cerebral Edema ll: Pathophysiology
Vasogenic edema is a major form of cerebral edema characterized by abnormal accumulation of fluid in the brain’s extracellular space due to disruption of the blood–brain barrier (BBB). The BBB is a specialized structure composed of endothelial cells connected by tight junctions, supported by astrocytic endfeet and a basement membrane. Under normal conditions, it tightly regulates the movement of ions, proteins, and solutes between the bloodstream and brain parenchyma. When this barrier loses...