ED Pathway for the Evaluation/Treatment of the Child with Suspected Raised Intracranial Pressure not Due to Trauma
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Symptoms of elevated intracranial pressure are non-specific. Clinicians should maintain a high index of suspicion for this diagnosis to reduce morbidity and mortality. It is not possible to predict the rate of increase of ICP based on a patient’s current signs and symptoms.
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Imaging Protocol
Imaging Modalities
Indications for Emergent Imaging
(as soon as possible)
Indications for PROMPT Imaging
(within 24 hours)
  • Any abnormality in mental status
  • Any concern for vital sign abnormality
  • Focal neurologic findings
  • Normal mental status, vital signs
  • Papilledema without other focal findings
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Imaging should occur without delay:

CT is immediately available, fast and often requires no sedation and is the optimal study choice for ill/unstable patients.

MRI may be substituted for stable patients when it is feasible and immediately available.

The patient must remain in a monitored medical setting until the study is completed and the results are available. Obtain other consultation as needed.

Imaging should occur within 24 hours:

MR is the optimal study if it is feasible and can be obtained within 24 hours.

CT should be obtained if MRI is not feasible or cannot be completed within 24 hours.

The ordering Attending clinician must assure that the patient has the study completed and act on the results when this is completed in the outpatient setting.

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Imaging Normal
Imaging Abnormal
Imaging Normal
Imaging Abnormal
  • Admit as needed for further treatment, evaluation
  • Setting is determined by patient condition, imaging results
  • Schedule MRI or other additional studies, Neurology, Neurosurgery, Neuro-ophthalmology and other Consultation as needed
  • Admit as needed for further treatment, evaluation
  • Setting is determined by patient condition, imaging results
  • Schedule MRI or other additional studies Neurology, Neurosurgery, Neuro-ophthalmology and other Consultation as needed
Posted : April 2014
Authors : J. Callahan, MD; J. Lavelle, MD; Y. Boswinkel, MD; B. Banwell, MD; D. Jaramillo, MD; E. Schwartz, MD;
R. Zimmerman, MD; G. Liu, MD; D. Licht, MD; J. Huh, MD; C. Harris, MD; M. Kirschen, MD; T. Mason, MD;