Under Pressure: Using Demographics and Admission Head CT Scan to Predict Intracranial Hypertension in Neurotrauma

Introduction: Better criteria are needed to guide decisions to place intracranial pressure (ICP) monitors for traumatic brain injury (TBI). This study assesses whether patient demographics and admission head CT scan findings can predict intracranial hypertension.

Methods: This retrospective chart review identified 393 patients at Indiana University Methodist Hospital between 2015-2023 that had severe TBI and underwent ICP monitoring. Multivariate logistic regression assessed the relationship between demographic factors and specific findings on admission head CT scan with initial intracranial hypertension (i-ICHTN) and delayed-onset intracranial hypertension (d-ICHTN) with normal initial ICP and later elevations. Demographics included were age, obesity, diabetes, hypertension, prior TBI, and prior craniotomy. Patients were divided into two groups: those that had upfront surgery prior to ICP monitor placement (group 1), and patients with ICP monitors placed on admission (group 2).

Results: Demographic factors were not significantly associated with i-ICHTN in either group.
In group 1, older age (OR 0.110, 95% CI 0.016–0.747, p=0.024) was associated with decreased risk of d-ICHTN. Subdural hematoma (OR 0.086, 95% CI 0.009–0.790, p=0.030) and intraparenchymal hematoma (OR 0.135, 95% CI 0.019–0.965, p=0.046) were associated with decreased risk of i-ICHTN. Subarachnoid hemorrhage was associated with increased risk of i-ICHTN (OR 20.759, 95% CI 1.964–219.425, p=0.012) and d-ICHTN (OR 8.094, 95% CI 1.036–63.226, p=0.046).
In group 2, obesity was associated with increased risk of d-ICHTN (OR 2.166, 95% CI 1.102–4.260, p=0.025) while age was associated with decreased risk of d-ICHTN (OR 0.947, 95% CI 0.927–0.967, p< 0.001). Complete basal cistern effacement was associated with increased risk of i-ICHTN (OR 3.833, 95% CI 1.684–8.726, p=0.001).

Conclusion : Patient age and obesity, in combination with initial CT hemorrhage pattern, are valuable predictors of immediate and delayed ICP derangements in neurotrauma patients managed medically or surgically. Integrating these parameters into clinical practice can improve decision-making and optimize ICP management.