Accuracy of Manual Intracranial Pressure Recording Compared to a Computerized High-Resolution System: A CENTER-TBI Analysis.
Cerebral perfusion pressure
Data collection
Intracranial pressure
Traumatic brain injury
Journal
Neurocritical care
ISSN: 1556-0961
Titre abrégé: Neurocrit Care
Pays: United States
ID NLM: 101156086
Informations de publication
Date de publication:
06 2023
06 2023
Historique:
received:
12
09
2022
accepted:
09
02
2023
medline:
7
6
2023
pubmed:
17
3
2023
entrez:
16
3
2023
Statut:
ppublish
Résumé
Monitoring intracranial pressure (ICP) and cerebral perfusion pressure (CPP) is crucial in the management of the patient with severe traumatic brain injury (TBI). In several institutions ICP and CPP are summarized hourly and entered manually on bedside charts; these data have been used in large observational and interventional trials. However, ICP and CPP may change rapidly and frequently, so data recorded in medical charts might underestimate actual ICP and CPP shifts. The aim of this study was to evaluate the accuracy of manual data annotation for proper capturing of ICP and CPP. For this aim, we (1) compared end-hour ICP and CPP values manually recorded (MR) with values recorded continuously by computerized high-resolution (HR) systems and (2) analyzed whether MR ICP and MR CPP are reliable indicators of the burden of intracranial hypertension and low CPP. One hundred patients were included. First, we compared the MR data with the values stored in the computerized system during the first 7 days after admission. For this point-to-point analysis, we calculated the difference between end-hour MR and HR ICP and CPP. Then we analyzed the burden of high ICP (> 20 mm Hg) and low CPP (< 60 mm Hg) measured by the computerized system, in which continuous data were stored, compared with the pressure-time dose based on end-hour measurements. The mean difference between MR and HR end-hour values was 0.02 mm Hg for ICP (SD 3.86 mm Hg) and 1.54 mm Hg for CPP (SD 8.81 mm Hg). ICP > 20 mm Hg and CPP < 60 mm Hg were not detected by MR in 1.6% and 5.8% of synchronized measurements, respectively. Analysis of the pathological ICP and CPP throughout the recording, however, indicated that calculations based on manual recording seriously underestimated the ICP and CPP burden (in 42% and 28% of patients, respectively). Manual entries fairly represent end-hour HR ICP and CPP. However, compared with a computerized system, they may prove inadequate, with a serious risk of underestimation of the ICP and CPP burden.
Sections du résumé
BACKGROUND
Monitoring intracranial pressure (ICP) and cerebral perfusion pressure (CPP) is crucial in the management of the patient with severe traumatic brain injury (TBI). In several institutions ICP and CPP are summarized hourly and entered manually on bedside charts; these data have been used in large observational and interventional trials. However, ICP and CPP may change rapidly and frequently, so data recorded in medical charts might underestimate actual ICP and CPP shifts. The aim of this study was to evaluate the accuracy of manual data annotation for proper capturing of ICP and CPP. For this aim, we (1) compared end-hour ICP and CPP values manually recorded (MR) with values recorded continuously by computerized high-resolution (HR) systems and (2) analyzed whether MR ICP and MR CPP are reliable indicators of the burden of intracranial hypertension and low CPP.
METHODS
One hundred patients were included. First, we compared the MR data with the values stored in the computerized system during the first 7 days after admission. For this point-to-point analysis, we calculated the difference between end-hour MR and HR ICP and CPP. Then we analyzed the burden of high ICP (> 20 mm Hg) and low CPP (< 60 mm Hg) measured by the computerized system, in which continuous data were stored, compared with the pressure-time dose based on end-hour measurements.
RESULTS
The mean difference between MR and HR end-hour values was 0.02 mm Hg for ICP (SD 3.86 mm Hg) and 1.54 mm Hg for CPP (SD 8.81 mm Hg). ICP > 20 mm Hg and CPP < 60 mm Hg were not detected by MR in 1.6% and 5.8% of synchronized measurements, respectively. Analysis of the pathological ICP and CPP throughout the recording, however, indicated that calculations based on manual recording seriously underestimated the ICP and CPP burden (in 42% and 28% of patients, respectively).
CONCLUSIONS
Manual entries fairly represent end-hour HR ICP and CPP. However, compared with a computerized system, they may prove inadequate, with a serious risk of underestimation of the ICP and CPP burden.
Identifiants
pubmed: 36922475
doi: 10.1007/s12028-023-01697-2
pii: 10.1007/s12028-023-01697-2
pmc: PMC10241732
doi:
Types de publication
Comparative Study
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
781-790Investigateurs
Audny Anke
(A)
Ronny Beer
(R)
Bo-Michael Bellander
(BM)
Erta Beqiri
(E)
Andras Buki
(A)
Manuel Cabeleira
(M)
Arturo Chieregato
(A)
Giuseppe Citerio
(G)
Hans Clusmann
(H)
Endre Czeiter
(E)
Marek Czosnyka
(M)
Bart Depreitere
(B)
Ari Ercole
(A)
Shirin Frisvold
(S)
Raimund Helbok
(R)
Stefan Jankowski
(S)
Daniel Kondziella
(D)
Lars-Owe Koskinen
(LO)
Ana Kowark
(A)
David K Menon
(DK)
Geert Meyfroidt
(G)
Kirsten Moeller
(K)
David Nelson
(D)
Anna Piippo-Karjalainen
(A)
Andreea Radoi
(A)
Arminas Ragauskas
(A)
Rahul Raj
(R)
Jonathan Rhodes
(J)
Saulius Rocka
(S)
Rolf Rossaint
(R)
Juan Sahuquillo
(J)
Oliver Sakowitz
(O)
Peter Smielewski
(P)
Nina Sundström
(N)
Riikka Takala
(R)
Tomas Tamosuitis
(T)
Olli Tenovuo
(O)
Andreas Unterberg
(A)
Peter Vajkoczy
(P)
Alessia Vargiolu
(A)
Rimantas Vilcinis
(R)
Stefan Wolf
(S)
Alexander Younsi
(A)
Frederick A Zeiler
(FA)
Commentaires et corrections
Type : ErratumIn
Informations de copyright
© 2023. The Author(s).
Références
Carney N, Totten AM, O’Reilly C, Ullman JS, Hawryluk GW, Bell MJ, Bratton SL, Chesnut R, Harris OA, Kissoon N, Rubiano AM, Shutter L, Tasker RC, Vavilala MS, Wilberger J, Wright DW, Ghajar J. Guidelines for the management of severe traumatic brain injury. Neurosurgery. 2017;80(1):6–15. https://doi.org/10.1227/NEU.0000000000001432 .
doi: 10.1227/NEU.0000000000001432
pubmed: 27654000
Le Roux P, Menon DK, Citerio G, Vespa P, Bader MK, Brophy G, Diringer MN, Stocchetti N, Videtta W, Armonda R, Badjatia N, Bösel J, Chesnut R, Chou S, Claassen J, Czosnyka M, De Georgia M, Figaji A, Fugate J, Helbok R, Horowitz D, Hutchinson P, Kumar M, McNett M, Miller C, Naidech A, Oddo M, Olson D, O’Phelan K, Provencio JJ, Puppo C, Riker R, Roberson C, Schmidt M, Taccone F. The international multidisciplinary consensus conference on multimodality monitoring in neurocritical care: a list of recommendations and additional conclusions: a statement for healthcare professionals from the neurocritical care society and the European society of intensive care medicine. Neurocrit Care. 2014;21(Suppl 2):S282–96. https://doi.org/10.1007/s12028-014-0077-6 .
doi: 10.1007/s12028-014-0077-6
pubmed: 25501689
pmcid: 7888245
Robba C, Graziano F, Rebora P, Elli F, Giussani C, Oddo M, Meyfroidt G, Helbok R, Taccone FS, Prisco L, Vincent JL, Suarez JI, Stocchetti N, Citerio G, SYNAPSE-ICU Investigators. Intracranial pressure monitoring in patients with acute brain injury in the intensive care unit (SYNAPSE-ICU): an international, prospective observational cohort study. Lancet Neurol. 2021;20(7):548–58. https://doi.org/10.1016/S1474-4422(21)00138-1 .
doi: 10.1016/S1474-4422(21)00138-1
pubmed: 34146513
Treggiari MM, Schutz N, Yanez ND, Romand JA. Role of intracranial pressure values and patterns in predicting outcome in traumatic brain injury: a systematic review. Neurocrit Care. 2007;6(2):104–12. https://doi.org/10.1007/s12028-007-0012-1 .
doi: 10.1007/s12028-007-0012-1
pubmed: 17522793
Donnelly J, Czosnyka M, Adams H, Cardim D, Kolias AG, Zeiler FA, Lavinio A, Aries M, Robba C, Smielewski P, Hutchinson PJA, Menon DK, Pickard JD, Budohoski KP. Twenty-five years of intracranial pressure monitoring after severe traumatic brain injury: a retrospective, Single-center analysis. Neurosurgery. 2019;85(1):E75-82. https://doi.org/10.1093/neuros/nyy468 .
doi: 10.1093/neuros/nyy468
pubmed: 30476233
Jha RM, Elmer J, Zusman BE, Desai S, Puccio AM, Okonkwo DO, Park SY, Shutter LA, Wallisch JS, Conley YP, Kochanek PM. Intracranial pressure trajectories: a novel approach to informing severe traumatic brain injury phenotypes. Crit Care Med. 2018;46(11):1792–802. https://doi.org/10.1097/CCM.0000000000003361 .
doi: 10.1097/CCM.0000000000003361
pubmed: 30119071
pmcid: 6185785
Åkerlund CA, Donnelly J, Zeiler FA, Helbok R, Holst A, Cabeleira M, Güiza F, Meyfroidt G, Czosnyka M, Smielewski P, Stocchetti N, Ercole A, Nelson DW, CENTER-TBI High Resolution ICU Sub-Study Participants and Investigators. Impact of duration and magnitude of raised intracranial pressure on outcome after severe traumatic brain injury: A CENTER-TBI high-resolution group study. PLoS ONE. 2020;15(12):e0243427. https://doi.org/10.1371/journal.pone.0243427 .
doi: 10.1371/journal.pone.0243427
pubmed: 33315872
pmcid: 7735618
Güiza F, Depreitere B, Piper I, Citerio G, Chambers I, Jones PA, et al. Visualizing the pressure and time burden of intracranial hypertension in adult and paediatric traumatic brain injury. Intensive Care Med. 2015;41:1067–76. https://doi.org/10.1007/s00134-015-3806-1 .
doi: 10.1007/s00134-015-3806-1
pubmed: 25894624
Zeiler FA, Ercole A, Cabeleira M, Beqiri E, Zoerle T, Carbonara M, Stocchetti N, Menon DK, Lazaridis C, Smielewski P, Czosnyka M, CENTER-TBI High Resolution ICU Sub-Study Participants and Investigators. Patient-specific ICP epidemiologic thresholds in adult traumatic brain injury: a CENTER-TBI validation study. J Neurosurg Anesthesiol. 2021;33(1):28–38. https://doi.org/10.1097/ANA.0000000000000616 .
doi: 10.1097/ANA.0000000000000616
pubmed: 31219937
Stocchetti N, Colombo A, Ortolano F, Videtta W, Marchesi R, Longhi L, Zanier ER. Time course of intracranial hypertension after traumatic brain injury. J Neurotrauma. 2007;24(8):1339–46. https://doi.org/10.1089/neu.2007.0300 .
doi: 10.1089/neu.2007.0300
pubmed: 17711395
Hutchinson PJ, Kolias AG, Timofeev IS, Corteen EA, Czosnyka M, Timothy J, Anderson I, Bulters DO, Belli A, Eynon CA, Wadley J, Mendelow AD, Mitchell PM, Wilson MH, Critchley G, Sahuquillo J, Unterberg A, Servadei F, Teasdale GM, Pickard JD, Menon DK, Murray GD, Kirkpatrick PJ, RESCUEicp Trial Collaborators. Trial of decompressive craniectomy for traumatic intracranial hypertension. N Engl J Med. 2016;375(12):1119–30. https://doi.org/10.1056/NEJMoa1605215 .
doi: 10.1056/NEJMoa1605215
pubmed: 27602507
Cooper DJ, Rosenfeld JV, Murray L, Arabi YM, Davies AR, D’Urso P, Kossmann T, Ponsford J, Seppelt I, Reilly P, Wolfe R, DECRA Trial Investigators; Australian and New Zealand Intensive Care Society Clinical Trials Group. Decompressive craniectomy in diffuse traumatic brain injury. N Engl J Med. 2011;364(16):1493–502. https://doi.org/10.1056/NEJMoa1102077 .
doi: 10.1056/NEJMoa1102077
pubmed: 21434843
Andrews PJ, Sinclair HL, Rodriguez A, Harris BA, Battison CG, Rhodes JK, Murray GD, Eurotherm3235 Trial Collaborators. Hypothermia for intracranial hypertension after traumatic brain injury. N Engl J Med. 2015;373(25):2403–12. https://doi.org/10.1056/NEJMoa1507581 .
doi: 10.1056/NEJMoa1507581
pubmed: 26444221
Chesnut RM, Temkin N, Carney N, Dikmen S, Rondina C, Videtta W, Petroni G, Lujan S, Pridgeon J, Barber J, Machamer J, Chaddock K, Celix JM, Cherner M, Hendrix T, Global Neurotrauma Research Group. A trial of intracranial-pressure monitoring in traumatic brain injury. N Engl J Med. 2012;367(26):2471–81. https://doi.org/10.1056/NEJMoa1207363 .
doi: 10.1056/NEJMoa1207363
pubmed: 23234472
pmcid: 3565432
Okonkwo DO, Shutter LA, Moore C, Temkin NR, Puccio AM, Madden CJ, Andaluz N, Chesnut RM, Bullock MR, Grant GA, McGregor J, Weaver M, Jallo J, LeRoux PD, Moberg D, Barber J, Lazaridis C, Diaz-Arrastia RR. Brain oxygen optimization in severe traumatic brain injury phase-II: a phase II randomized trial. Crit Care Med. 2017;45(11):1907–14. https://doi.org/10.1097/CCM.0000000000002619 .
doi: 10.1097/CCM.0000000000002619
pubmed: 29028696
pmcid: 5679063
Citerio G, Park S, Schmidt JM, Moberg R, Suarez JI, Le Roux PD, Second neurocritical care research conference investigators. Data collection and interpretation. Neurocrit Care. 2015;22(3):360–8. https://doi.org/10.1007/s12028-015-0139-4 .
doi: 10.1007/s12028-015-0139-4
pubmed: 25846711
Huijben JA, Wiegers EJA, Lingsma HF, Citerio G, Maas AIR, Menon DK, Ercole A, Nelson D, van der Jagt M, Steyerberg EW, Helbok R, Lecky F, Peul W, Birg T, Zoerle T, Carbonara M, Stocchetti N, CENTER-TBI investigators and participants. Changing care pathways and between-center practice variations in intensive care for traumatic brain injury across Europe: a CENTER-TBI analysis. Intensive Care Med. 2020;46(5):995–1004. https://doi.org/10.1007/s00134-020-05965-z .
doi: 10.1007/s00134-020-05965-z
pubmed: 32100061
pmcid: 7210239
Zanier ER, Ortolano F, Ghisoni L, Colombo A, Losappio S, Stocchetti N. Intracranial pressure monitoring in intensive care: clinical advantages of a computerized system over manual recording. Crit Care. 2007;11(1):R7. https://doi.org/10.1186/cc5155 .
doi: 10.1186/cc5155
pubmed: 17233895
pmcid: 2151894
Hemphill JC III, Barton CW, Morabito D, Manley GT. Influence of data resolution and interpolation method on assessment of secondary brain insults in neurocritical care. Physiol Meas. 2005;26:373–86. https://doi.org/10.1088/0967-3334/26/4/004 .
doi: 10.1088/0967-3334/26/4/004
pubmed: 15886433
Magni F, Pozzi M, Rota M, Vargiolu A, Citerio G. High-resolution intracranial pressure burden and outcome in subarachnoid hemorrhage. Stroke. 2015;46(9):2464–9. https://doi.org/10.1161/STROKEAHA.115.010219 .
doi: 10.1161/STROKEAHA.115.010219
pubmed: 26243224
Piper I, Chambers I, Citerio G, Enblad P, Gregson B, Howells T, Kiening K, Mattern J, Nilsson P, Ragauskas A, Sahuquillo J, Donald R, Sinnott R, Stell A, BrainIT Group. The brain monitoring with Information Technology (BrainIT) collaborative network: EC feasibility study results and future direction. Acta Neurochir (Wien). 2010;152(11):1859–71. https://doi.org/10.1007/s00701-010-0719-1 .
doi: 10.1007/s00701-010-0719-1
pubmed: 20589400
Turner HB, Anderson RL, Ward JD, Young HF, Marmarou A. Comparison of nurse and computer recording of ICP in head injured patients. J Neurosci Nurs. 1988;20:236–9.
doi: 10.1097/01376517-198808000-00006
pubmed: 2973500
Venkatesh B, Garrett P, Fraenkel DJ, Purdie D. Indices to quantify changes in intracranial and cerebral perfusion pressure by assessing agreement between hourly and semi-continuous recordings. Intensive Care Med. 2004;30(3):510–3. https://doi.org/10.1007/s00134-003-2102-7 .
doi: 10.1007/s00134-003-2102-7
pubmed: 14997296
Chu KH, Beqiri E, Czosnyka M, Smielewski P. Comparison of Two intracranial pressure calculation methods and their effects on the mean intracranial pressure and intracranial pressure dose. Acta Neurochir Suppl. 2021;131:31–3. https://doi.org/10.1007/978-3-030-59436-7_7 .
doi: 10.1007/978-3-030-59436-7_7
pubmed: 33839813
Vik A, Nag T, Fredriksli OA, Skandsen T, Moen KG, Schirmer-Mikalsen K, Manley GT. Relationship of “dose” of intracranial hypertension to outcome in severe traumatic brain injury. J Neurosurg. 2008;109(4):678–84. https://doi.org/10.3171/JNS/2008/109/10/0678 .
doi: 10.3171/JNS/2008/109/10/0678
pubmed: 18826355
Kahraman S, Dutton RP, Hu P, Xiao Y, Aarabi B, Stein DM, Scalea TM. Automated measurement of “pressure times time dose” of intracranial hypertension best predicts outcome after severe traumatic brain injury. J Trauma. 2010;69(1):110–8. https://doi.org/10.1097/TA.0b013e3181c99853 .
doi: 10.1097/TA.0b013e3181c99853
pubmed: 20038855
Sheth KN, Stein DM, Aarabi B, Hu P, Kufera JA, Scalea TM, Hanley DF. Intracranial pressure dose and outcome in traumatic brain injury. Neurocrit Care. 2013;18(1):26–32. https://doi.org/10.1007/s12028-012-9780-3 .
doi: 10.1007/s12028-012-9780-3
pubmed: 23055087