Assessment of Intracranial Pressure in Pediatric Traumatic Brain Injury: Methods, Evidence, and Clinical Implications

Abstract

Background: Pediatric traumatic brain injury (TBI) is one of the leading causes of disability and early mortality, constituting a global public health problem. Even mild TBI can cause neurological deterioration due to secondary brain injury, usually associated with elevated intracranial pressure (ICP) compromising cerebral perfusion. Early identification and appropriate management of intracranial hypertension are therefore fundamental in the care of this population. Methods: A narrative review of the literature was conducted to identify and synthesize current evidence on ICP monitoring methods in children and adolescents, encompassing original articles, systematic reviews, meta-analyses, and clinical guidelines. Results: ICPM is an essential tool for preventing secondary brain injuries, guiding therapeutic interventions, and maintaining ICP and cerebral perfusion pressure within target ranges. Invasive methods, particularly the external ventricular drain, remain the gold standard for accuracy and allow direct therapeutic intervention, but carry risks of infection and hemorrhage. Intraparenchymal sensors offer a safer alternative with comparable accuracy. Noninvasive methods, including optic nerve sheath diameter ultrasonography, transcranial Doppler, and skull surface extensometry, demonstrate reasonable ability to detect intracranial hypertension and are particularly useful for triage, screening, and follow-up, though they do not yet replace invasive monitoring in critical clinical decisions. Conclusions: The choice of ICP monitoring method should be individualized, balancing accuracy, safety, available resources, and the patient's clinical context. In severe TBI, invasive methods remain indispensable, whereas noninvasive approaches play a complementary role, particularly when invasive access is contraindicated or unavailable. Integrating multiple monitoring strategies may optimize ICP assessment in the pediatric population.