Prospective Study on Noninvasive Assessment of Intracranial Pressure in Traumatic Brain-Injured Patients: Comparison of Four Methods
Danilo Cardim , Chiara Robba , Joseph Donnelly , Michał Bohdanowicz , B Schmidt , Maxwell Damian , Georgios V Varsos , X. Liu , Manuel Cabeleira , Gustavo Frigieri , Brenno Cabella , Peter Smielewski , Sergio Mascarenhas , Marek Czosnyka
AbstractElevation of intracranial pressure (ICP) may occur in many diseases, and therefore the ability to measure it noninvasively would be useful. Flow velocity signals from transcranial Doppler (TCD) have been used to estimate ICP; however, the relative accuracy of these methods is unclear. This study aimed to compare four previously described TCD-based methods with directly measured ICP in a prospective cohort of traumatic brain-injured patients. Noninvasive ICP (nICP) was obtained using the following methods: 1) a mathematical ‘‘black-box’’ model based on interaction between TCD and arterial blood pressure (nICP_BB); 2) based on diastolic flow velocity (nICP_FVd); 3) based on critical closing pressure (nICP_CrCP); and 4) based on TCD-derived pulsatility index (nICP_PI). In time domain, for recordings including spontaneous changes in ICP greater than 7mm Hg, nICP_PI showed the best correlation with measured ICP (R = 0.61). Considering every TCD recording as an independent event, nICP_BB generally showed to be the best estimator of measured ICP (R = 0.39; p < 0.05; 95% confidence interval [CI] = 9.94mm Hg; area under the curve [AUC] = 0.66; p < 0.05). For nICP_FVd, although it presented similar correlation coefficient to nICP_BB and marginally better AUC (0.70; p < 0.05), it demonstrated a greater 95% CI for prediction of ICP (14.62mm Hg). nICP_CrCP presented a moderate correlation coefficient (R = 0.35; p < 0.05) and similar 95% CI to nICP_BB (9.19mm Hg), but failed to distinguish between normal and raised ICP (AUC = 0.64; p > 0.05). nICP_PI was not related to measured ICP using any of the above statistical indicators. We also introduced a new estimator (nICP_Av) based on the average of three methods (nICP_BB, nICP_FVd, and nICP_CrCP), which overall presented improved statistical indicators (R = 0.47; p < 0.05; 95% CI = 9.17mm Hg; AUC= 0.73; p < 0.05). nICP_PI appeared to reflect changes in ICP in time most accurately. nICP_BB was the best estimator for ICP ‘‘as a number.’’ nICP_Av demonstrated to improve the accuracy of measured ICP estimation.
|Journal series||Journal of Neurotrauma, ISSN 0897-7151|
|Publication size in sheets||0.5|
|Keywords in English||noninvasive ICP monitoring, transcranial Doppler, traumatic brain injury|
|Score|| = 35.0, 02-11-2017, ArticleFromJournal|
= 35.0, 02-11-2017, ArticleFromJournal
|Publication indicators||: 2016 = 5.19 (2) - 2016=4.797 (5)|
|Citation count*||14 (2018-02-21)|
* presented citation count is obtained through Internet information analysis and it is close to the number calculated by the Publish or Perish system.