186 Predicting the Requirement for Intracranial Pressure Monitoring in Pediatric Traumatic Brain Injury

INTRODUCTION Each year, the annual hospitalization rates of traumatic brain injury (TBI) in children in the US are 57.7/100K less than 5 years of age and 23.1/100K in the 5–14 year age group. Although technological advances in multi-modality monitoring allow for high frequency monitoring of the physiological pressure variables, a recent randomised-control trial in adults has questioned the requirement for invasive monitoring. Here in, we describe an objective, non-invasive, quantitative means of stratifying which patients are likely to benefit from invasive monitoring. METHODS Radiological biomarkers of TBI (optic nerve sheath diameter; ONSD, basal cistern size, ventricular volume, volume of extra-axial masses, parenchymal oedema) were measured by independent observers and quantified by automatic software (3D slicer, Boston, MA) and correlated with epochs of continuous high frequency variables of pressure monitoring around the time of imaging, in pediatric TBI patients admitted to Cambridge University Hospital (CUH) between January 2009 and December 2016. RESULTS >42 patients with a mean age of 10.3 years were admitted to CUH with a TBI and required invasive monitoring. The ICP was 19.6? ±?7.8 mmHg (median±IQR). The presence of subarachnoid blood was related to higher ICP, higher arterial blood pressure, and a trend toward dysfunctional cerebrovascular autoregulation (PRx). Smaller basal cisterns were related to increased ICP (R = −0.42, P = 0.02), impaired PRx (R = −0.5, P = 0.003). The correlation of mean ONSD and max ONSD with ICP was 0.725 (P < 0.0001) and 0.698 (P < 0.0001), respectively. CONCLUSION Here we define a set of radiological criteria to help predict the development of unfavourable intracranial pressure variables after a pediatric TBI. The use of objective radiological markers in this model can be tested on an external database to validate the relationship with intracranial pressure.