Results and complications of intracranial pressure monitoring in 303 children

Abstract

303 consecutive children who had insertion of an intracranial pressure (ICP) monitor for various reasons were reviewed to determine clinical value and complications rate of ICP monitoring in this age group. 286 patients had a Camino fiberoptic monitor. Of the remaining cases, 9 had a ventricular catheter, 7 had an extradural Gaeltec monitor, and 1 had a subdural feeding tube. The reasons for monitoring the ICP were: trauma in 132 children, postoperative monitoring after tumor surgery in 91, head injury due to child abuse in 30, severe medical conditions such as meningitis, encephalitis, and near-drowning in 30, intracranial hemorrhage in 15, and hydrocephalus in 5 children. The median age at insertion was 6 years (range from 1 month to 17 years), and the median Glasgow coma score before insertion was 7. Median duration of monitoring was 3 days, and 35 children (10%) had surgical procedures performed for raised ICP detected by monitoring. 238 (78%) had nonsurgical measures to control raised ICP. 6 (15%) of 40 children with an initial ICP > 50 mm Hg made a good recovery, but there were no survivors among 37 children who had an ICP consistently > 60 mm Hg and only 1 disabled survivor among 42 children with an ICP consistently > 50 mm Hg. The outcome in all 303 children correlated with averaged readings of ICP over 24 h and initial Glasgow coma score, but did not correlate with initial ICP measurements. Complications of monitoring were few and consisted of infection in 1 (0.3%) child, intracranial hemorrhage in 1 (0.3%) who had low platelet counts, displacement of monitor in 3 (1%), and malfunction of monitor in 8 (2.6%) children. We conclude that ICP monitoring in the pediatric age group substantially influences our clinical management of unconscious children and is safe.