The authors correlated the computed tomographic (CT) findings and intracranial pressure (ICP) in 150 consecutive comatose head injury patients to determine if noninvasive CT can help identify the patients not requiring ICP monitoring. The study reveals that a majority of patients (55%) with hemorrhagic lesions shown by CT suffer from intracranial hypertension and require ICP monitoring for proper management. Of the patients with normal initial CT, 98% had normal ICP during the first 24 hr. Of the patients with normal CT, 15% developed intracranial hypertension later, irrespective of the initial Glasgow coma scale score or age. More than half of the patients who developed intracranial hypertension subsequently had normal ICP through the first 48 hr. The study indicates that ICP monitoring need not routinely be performed on admission on severe head injury patients with a normal CT. However, repeat CT at 24--48 hr before ICP monitoring in patients with initially normal CT may be valuable, particularly if their clinical status deteriorates.