Alali et al reported a clinical decision rule to predict intracranial hypertension in a patient with severe traumatic brain injury. This can help to identify a patient who should have intracranial pressure monitored and therapy initiated. The authors are from the University of Washington, Hospital Emergencia Dr Clemente Alvarez (Argentina), Hospital Emergencia Hospital Privado de Rosario, Hospital Erasmo Meoz (Columbia).

Patient selection: severe traumatic brain injury (TBI)


Definition of intracranial hypertension for primary analysis: hourly intracranial pressure (ICP) > 22 mm Hg in any hour


Major criteria:

(1) compressed cisterns (Marshall diffuse injury III on CT)

(2) midline shift > 5 mm (Marshall diffuse injury IV on CT)

(3) non-evacuated mass lesion > 25 cubic cm


Minor criteria:

(1) Glasgow coma motor scale <= 4

(2) pupillary asymmetry (difference between pupil diameter > 1 mm)

(3) lack of reactivity to light in one or both pupils (abnormal pupillary reactivity)

(4) Marshall diffuse injury II on CT (midline shift < 5 mm and/or mass lesion <= 25 cubic cm)


High intracranial pressure should be suspected if one of the following is present:

(1) 1 or more major

(2) 2 or more minor

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