Prospective study on non-invasive assessment of ICP in head injured patients: comparison of four methods
Varsos, Georgios V
Journal of Neurotrauma
Mary Ann Liebert
MetadataShow full item record
Cardim, D., Robba, C., Donnelly, J., Bohdanowicz, M., Schmidt, B., Damian, M., Varsos, G. V., et al. (2015). Prospective study on non-invasive assessment of ICP in head injured patients: comparison of four methods. Journal of Neurotrauma, 33 792-802. https://doi.org/10.1089/neu.2015.4134
Elevation of intracranial pressure (ICP) may occur in many diseases and therefore the ability to measure it non-invasively 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 4 previously described TCD-based methods with directly measured ICP in a prospective cohort of head injured patients. Non-invasive ICP (nICP) was obtained using the following methods: I) a mathematical “black-box” model based on interaction between TCD and ABP (nICP_BB); II) based on diastolic FV (nICP_FVd); III) based on critical closing pressure (nICP_CrCP) and IV) based on TCD-derived pulsatility index (nICP_PI). In time domain, for recordings including spontaneous changes in ICP greater than 7 mmHg, 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% CI=9.94 mmHg; 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 (14.62 mmHg). nICP_CrCP presented a moderate correlation coefficient (R=0.35, p<0.05) and similar 95% CI to nICP_BB (9.19 mmHg), 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 3 methods (nICP_BB, nICP_FVd and nICP_CrCP), which overall presented improved statistical indicators (R=0.47, p<0.05; 95% CI=9.17 mmHg; 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.
Non-invasive ICP monitoring, Transcranial Doppler, Traumatic Brain Injury
DC is supported by a Cambridge Commonwealth, European & International Trust Scholarship, University of Cambridge. JD is supported by a Woolf Fisher Trust Scholarship. XL is supported by a Gates Cambridge Scholarship. GVV is supported by an A. G. Leventis Foundation Scholarship, and a Charter Studentship from St Edmund’s College, Cambridge. SM and GF are supported by the Pan-American Health Organization. DC and MC are partially supported by NIHR Brain Injury Healthcare Technology Co-operative, Cambridge, UK.
External DOI: https://doi.org/10.1089/neu.2015.4134
This record's URL: https://www.repository.cam.ac.uk/handle/1810/250472
Recommended or similar items
The current recommendation prototype on the Apollo Repository will be turned off on 03 February 2023. Although the pilot has been fruitful for both parties, the service provider IKVA is focusing on horizon scanning products and so the recommender service can no longer be supported. We recognise the importance of recommender services in supporting research discovery and are evaluating offerings from other service providers. If you would like to offer feedback on this decision please contact us on: firstname.lastname@example.org