Optimizing TBI Management: Insights into Pressure Monitoring and Biomarker Utilization

Each year, an estimated tens of millions are sustaining traumatic brain injuries worldwide, driving an urgent shift toward precision in care.

With so many injuries occurring each year, clinicians are increasingly turning to two complementary pillars to improve outcomes: precision in monitoring (especially accurate intracranial pressure and cerebral perfusion targets) and selective use of blood-based biomarkers to guide imaging.

Proper ICP transducer zeroing and leveling (for example, at the tragus to approximate the foramen of Monro) directly determines reading accuracy and downstream therapy; ICU reports highlight how zeroing/leveling errors can distort ICP and misguide treatment decisions, as detailed in this analysis of zeroing/leveling impact in neurocritical care.

Disturbances in cerebral perfusion pressure highlight the need for tailored pediatric management; by identifying and titrating to optimal CPP targets in children, clinicians can better align interventions with physiology, supported by STARSHIP’s analysis of pediatric CPP thresholds.

Taken together, accurate zeroing/leveling and child-specific CPP targets frame the implementation task: protocols that standardize leveling landmarks, verify zeroing after repositioning, and titrate CPP to individualized targets translate principles into practice.

In the emergency department, blood-based biomarkers such as GFAP and UCH-L1 are being used to aid CT decision-making for suspected mild TBI within defined post-injury windows; they can help reduce unnecessary scans and radiation exposure when used appropriately, though they are not diagnostic tests and have sensitivity/specificity limits, as summarized in this overview of biomarker-guided CT stewardship.

Key Takeaways:

• Monitoring precision matters: consistent ICP transducer zeroing/leveling and verification after patient movement underpin reliable data and treatment choices.
• In pediatrics, targeting CPP within child-appropriate thresholds helps align interventions with developmental physiology, guided by emerging analyses.
• Biomarkers such as GFAP/UCH-L1 can aid CT decision-making within defined post-injury windows; used judiciously, they support imaging stewardship and patient safety.