RESULTS AND COMPLICATIONS OF INTRACRANIAL-PRESSURE MONITORING IN 303 CHILDREN

303 consecutive children who had insertion of an intracranial pressure (ICP) monitor for various reasons were reviewed to determine clinical value and complication rate of ICP monitoring in this age group. 286 patients had a Camino fiberoptic monitor. Of the remaining cases, 9 ha d a ventricular catheter, 7 had an extradural Gaeltec monitor, and 1 h ad a subdural feeding tube. The reasons for monitoring the ICP were: t rauma in 132 children, postoperative monitoring after tumor surgery in 91, head injury due to child abuse in 30, severe medical conditions s uch 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 I month to 17 years), and the median Glasgow coma score before insertion was 7. Median duration of monitor ing was 3 days, and 35 children (10%) had surgical procedures performe d for raised ICP detected by monitoring. 238 (78%) had nonsurgical mea sures to control raised ICP. 6 (15%) of 40 children with an initial IC P >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 I disabled su rvivor among 42 children with an ICP consistently >50 mm Hg. The outco me in all 303 children correlated with averaged readings of ICP over 2 4 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%) w ho had low platelet counts, displacement of monitor in 3 (1%), and mal function of monitor in 8 (2.6%) children. We conclude that ICP monitor ing in the pediatric age group substantially influences our clinical m anagement of unconscious children and is safe.