American Academy of Nursing

View all recommendations from this society

March 21, 2017

Don’t use lumbar puncture (LP) opening pressure as a reliable measure of intracranial pressure in children with severe chronic headache.

There are many limitations with LP pressure measurement as it varies with patient position and level of the manometer. As a “snapshot in time,” it cannot be correlated with symptoms over time, and anesthetic agents can cause false readings. An intracranial monitor (bolt) measures intracranial pressure (ICP) over time as the patient goes about daily activities. Medical and surgical treatment decisions are based on relieving intracranial pressure. Inaccurate pressure readings can lead to unnecessary surgeries such as cranial vault expansion, shunt revisions and placement of lumbar-peritoneal shunts as well as unnecessary medical treatments.


These items are provided solely for informational purposes and are not intended as a substitute for consultation with a health professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician or nurse.

How The List Was Created

The American Academy of Nursing has convened a workgroup of member fellows who are leaders of professional nursing organizations representing a broad range of clinical expertise, practice settings and patient populations. The workgroup collaboratively identifies nursing/interdisciplinary interventions commonly used in clinical practice that do not contribute to improved patient outcomes or provide high value. An extensive literature search and review of practice guidelines is conducted for each new proposed recommendation for the list. The supporting evidence is then reviewed by the respective nursing organization(s) with the most relevant expertise to each recommendation. The Academy workgroup fellows narrow the recommendations through consensus, based on established criteria. The final recommendations are presented to the American Academy of Nursing’s Board of Directors for approval to be added to the Choosing Wisely list created by the Academy.

The American Academy of Nursing’s conflict of interests and disclosures policy can be found at www.AANnet.org.

Sources

Baird LC, Gonda D, Cohen SR, Evers LJ, LeFloch N, Levy ML, Meltzer HS. “Craniofacial reconstruction as a treatment for elevated intracranial pressure.” Child’s Nervous System. 2012; 28(3):411-418.

Cartwright CC & Igbaseimokumo U. “Lumbar puncture opening pressure is not a reliable measure of intracranial pressure in children.” Journal of Child Neurology. 2014; 30(2):170-3.

Eidlitz-Markus T, Stiebel-Kalish H, Rubin Y, Shuper A. CSF pressure measurement during anesthesia: an unreliable technique. Paediatric Anaesthesia. 2005; 15:1078-1082.

Horton CH. “Continuous intracranial pressure monitoring: a last resort in pseudotumor cerebri.” Journal of Neuro-Ophthalmology. 2011; 31:199-201.

Warden KF, Alizai AM, Trobe JD, Hoff JT. Short-term continuous intraparenchymal intracranial pressure monitoring in presumed idiopathic intracranial hypertension. Journal of Neuroophthalmology. 2011; 31:202-205.

Wiegand C & Richards P. “Measurement of intracranial pressure in children: a critical review of current methods.” Developmental Medicine and Child Neurology. 2007; 49:935-941.