Introduction: Severe head injury in childhood continues to be associated with considerable mortality and morbidity. Early surgical decompression may be beneficial but the ICP and CPP levels at which this might be indicated have yet to be defined and may vary with age. The objective of this study was to examine the relationship between thresholds of mean ICP & CPP over the first 6 hours and age in relation to outcome in paediatric head injury patients.
Methods: A total of 209 head injured children admitted to five UK hospitals were studied. Patients aged 2 to 16 years were included if they had a minimum of six hours of invasive monitoring. Mean values of ICP and CPP over this period were calculated and compared in those with independent (good recovery and moderate disability) and poor outcomes (severe disability, and death) for different age groups.
Results: There were 133 boys and 76 girls; 92 made a good recovery, 56 had moderate disability (148 independent outcome), 30 remained severely disabled and 31 died (61 poor outcome). There was a significant difference between those with independent and poor outcomes in relation to ICP (p<0.001) and CPP (p<0.001). Patients were divided into three groups according to age. The sensitivity of ICP and CPP in predicting outcome were similar for all groups but the specificity differed between groups. At a CPP of 50mmHg the specificity varied between the groups (2 to 6 years 0.47, 7 to 10 years 0.28 and 11 to 16 years 0.10) as it did at an ICP of 25mmHg (2 to 6 years 0.53, 7 to 10 years 0.44 and 11 to 16 years 0.38).
Discussion: Younger children may be able to tolerate lower perfusion pressures and still have an independent outcome. This is important in the identification of patients that might benefit from new treatments e.g. surgical decompression.
Chambers IR, Jones PA, Minns RA, Stobbart L, Mendelow AD, Tasker RC, Kirkham F. Which paediatric head injured patients might benefit from decompression? Thresholds of ICP and CPP in the first six hours. Oral presentation at the 12th International symposium on Intracranial Pressure and Brain Monitoring. Hong Kong 16-26th August 2004.
Dr. Iain R. Chambers, Cleveland Unit, Middlesbrough. Tel: +44 (0)1642-854-778.
Regional Medical Physics Department, Freeman Hospital, Newcastle upon Tyne, NE7 7DN, UK.
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