Decision Tree Model of Forsyth et al for Predicting Raised Intracranial Pressure (ICP) in a Pediatric Patient with Traumatic Brain Injury

Description

Forsyth et al developed a decision tree model for predicting raised intracranial pressure (ICP) in a pediatric patient with traumatic brain injury (TBI). This can help to identify a patient who may benefit from more aggressive management. The authors are from Royal Victoria Infirmary, University of Leeds, University of Warwick, Addenbrooke's Hospital and Princess of Wales Children's Hospital in England.

Patient selection: traumatic brain injury in a pediatric patient < 16 years old

Parameters (with odds ratios from logistic regression model):

(1) lateral ventricles on imaging studies (odds ratio 0.5 if normal, 1.9 if reduced)

(2) evidance of diffuse axonal injury (DAI) on CT (odds ratio 4)

(3) both pupils fixed and > 3 mm at any time during the first 24 hours after admission (odds ratio 8.5)

(4) systolic blood pressure (SBP) on admission

(5) grey and white matter differentiation

Lateral Ventricles	DAI on CT	Pupils	SBP	Grey and White Matter	Predicted ICP
normal	present	NA	NA	NA	high (12 of 17)
normal	absent	yes	NA	NA	high (1 of 2)
normal	absent	no	NA	NA	low (24 of 33)
effaced or obliterated	NA	NA	> 92.5	NA	high (22 of 31)
effaced or obliterated	NA	NA	< 92.5	normal	low (2 of 2)
effaced or obliterated	NA	NA	< 92.5	reduced	high (5 of 5)

where:

• A blood pressure of 92.5 might be hard to measure. In practice this would be >= 93 and < 93.

Other predictos from logistic regression model:

(1) subarachnoid hemorrhage on CT in first 24 hours (odds ratio 4.4)

(2) extradural hemorrhage on CT in first 24 hours (odds ratio 3.2)

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Description

Specialty

ICD-10