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7 Kochanek suggests that ICP monitoring is useful because screening assay of the association between intracranial hypertension (defined as >20?mm??Hg) and poor neurological outcome or death. This indicates that ICP is an important prognostic variable in patients that should be measured. Kochanek also reports that successful ICP monitor-based management of intracranial hypertension is associated with improved survival and neurological outcome. ICP monitoring following head injury can be routinely undertaken in an operating theatre or at the bedside in intensive care. Monitors are usually placed in the right-frontal region, under local anaesthesia, through a small burr hole made with a handheld twist drill. Various types of ICP monitors exist including intraventricular catheters, subdural and parenchymal, which are the most frequently used in head injury.8 It is a safe procedure and overall incidence of infection is 1.4% and, although intracranial haemorrage rates in the paediatric AR 42 population have been reported as 10%, all were graded as clinically silent and required no neurosurgical intervention.8 In anaesthetised or sedated children with severe TBI there is no clinical method of serial, reliable assessment of intracranial pressure without using invasive ICP monitoring. Despite this, only 59% of children presenting with severe TBI have ICP monitoring and only half of clinical units caring for these children use monitoring technology.9 The local hospital where this patient was treated initially in an adult intensive care unit (ICU) did not have facilities for ICP monitoring. Guidelines for the management of adults with severe TBI published in 2007 recommend that ICP monitoring is started in10: Salvageable patients with severe TBI (GCS and an abnormal CT scan. Patients with severe traumatic brain injury with a normal scan and two of the following features: age >40 years, unilateral or bilateral motor posturing or systolic blood pressure Inulin could consider invasive ICP monitoring in: Conscious children with abnormal CT head scans; Children with mild-to-moderate TBI in whom serial neurological examinations cannot be performed owing to pharmacological sedation or anaesthesia. ICP monitoring was not initially started in this anaesthetised patient and EDH only became apparent later on after poor neurological status on weaning of sedation. Following surgical evacuation, ICP became elevated, with repeat CT showing recurrent EDH. We suggest all head injury patients undergoing pharmacological sedation or anaesthesia in tertiary centres should undergo ICP monitoring.