The following is a summary of “Relationship between the shape of intracranial pressure pulse waveform and computed tomography characteristics in patients after traumatic brain injury,” published in the November 2023 issue of Critical Care by Kazimierska et al.

Traumatic brain injury (TBI) can cause midline shift and mass lesions, increasing the risk of death and disability. The shape of the intracranial pressure (ICP) pulse waveform reflects the brain’s ability to compensate for pressure changes and is altered in TBI.

Researchers performed a retrospective study to investigate the relationship between ICP pulse shape and abnormal computed tomography (CT) findings in patients with traumatic brain injury.

They analyzed 130 TBI patients in the CENTER-TBI high-resolution sub-study. Midline shift, lesion volume, Marshall, and Rotterdam scores were evaluated in the initial CT scan after admission and compared with indices derived from the first 24 hours of ICP recording: mean ICP, pulse amplitude of ICP (AmpICP), and pulse shape index (PSI). An automated neural network model classified ICP pulses into four categories and calculated a pulse shape index (PSI). The relationship between each metric and CT measures was assessed using the Mann–Whitney U test (groups with midline shift > 5 mm or lesions > 25 cm3 present/absent) and the Spearman correlation coefficient. The ability of ICP-derived metrics to identify patients with pathological CT findings was assessed using the area under the receiver operating characteristic curve (AUC).

The results showed that PSI was notably higher in patients with mass lesions (with lesions: 2.4 [1.9–3.1] vs. 1.8 [1.1–2.3] in those without; P<< 0.001) and those with midline shift (2.5 [1.9–3.4] vs. 1.8 [1.2–2.4]; P< 0.001), while mean ICP and AmpICP exhibited similar values. PSI significantly correlated with the extent of midline shift, total lesion volume, and the Marshall and Rotterdam scores. PSI demonstrated AUCs > 0.7 in classifying patients with pathological CT features, in contrast to AUCs ≤ 0.6 for mean ICP and AmpICP.

They concluded that ICP pulse shape may be a complementary monitoring tool for assessing intracranial pressure dynamics and predicting adverse outcomes in TBI patients.

Source: ccforum.biomedcentral.com/articles/10.1186/s13054-023-04731-z