Identifying Clinical Predictors of Raised Intracranial Pressure in Pediatric Traumatic Brain Injury—A Multinational Initiative

Use of the intracranial pressure (ICP) monitor in pediatric traumatic brain injury (TBI) remains variable. Clinical prediction models of raised ICP have been reported in adult TBI but have not been validated in pediatric TBI. We aimed to investigate clinical predictors and derive a prediction model for raised ICP in pediatric patients with TBI. A real-world observational study was conducted among pediatric intensive care units from the Pediatric Acute & Critical Care Medicine Asian Network and Red Colaborativa Pediátrica de Latinoamerica. Children <18 years with moderate-to-severe TBI and who were hospitalized between 2014 and 2022 were included. We defined raised ICP as >20 mmHg. Multivariable logistic regression models were built to identify significant predictors for raised ICP, and performance was assessed using the area under the receiver operating characteristic curve (AUC). Among 706 pediatric patients, only 151 (21.4%) had ICP monitoring, and 75 (49.7%) were confirmed to have raised ICP. Mortality was 13.2%, 8.0%, and 4.0% for patients who did not receive ICP monitoring, those with raised ICP, and those with normal ICP, respectively (p = 0.037). A model predicting for raised ICP comprising sex, Glasgow Coma Scale motor score, leukocytosis, thrombocytopenia, and skull fracture on computed tomography performed with a sensitivity, specificity, and AUC of 56.0% (95% confidence interval [CI]: 44.8%−67.2%), 75.0% (95% CI: 65.3%−84.7%), and 73.7% (95% CI: 65.7%−81.6%), respectively. We report clinical predictors associated with raised ICP in pediatric TBI. The clinical prediction model was not sensitive, and future large-scale prospective studies should stratify predictors by specific intracranial pathologies.