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Emergency Intracranial Pressure Monitoring in Pediatrics

Management of the Acute Coma of Brain Insult

Department of Pediatrics, Georgetown University School of Medicine, Washington, D.C.

Marion L. Walker

Departments of Neurosurgery and Pediatrics, University of Utah College of Medicine, Salt Lake City, Utah

Over an 18-month period, 56 pediatric patients who sustained severe neurologic insults under went intracranial pressure (ICP) monitoring. Indications for monitoring ICP were (1) a Glasgow Coma Scale (GCS) score of 7 or less or (2) loss of consciousness with inability to utter recognizable words or follow commands. Diagnoses were head trauma (n = 40), Reye's syndrome (n = 10), and hypoxic encephalopathy due to near-drowning (n = 6). Eighty per cent of patients had ICP el evations requiring treatment. The complication rate was 5.3 per cent, with no serious compli cations or infections noted. Overall mortality was 14 per cent, but patients with hypoxic en cephalopathy had significantly higher mortality (33%) when compared to patients with head trauma (12.5%) or Reye's syndrome (10%). Other factors associated with a poor outcome included presence of an intracranial mass lesion, GCS score, ICP elevations, hypoxemia, hypotension, hypercarbia, and the presence of multiple injuries (p < 0.01). Early diagnosis and aggressive treatment in these patients, including the use of ICP monitoring, has resulted in acceptable recovery in over 85 per cent of these patients.

Clinical Pediatrics, Vol. 21, No. 7, 391-396 (1982)
DOI: 10.1177/000992288202100701


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