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1. Brain Temperature Influences Intracranial Pressure and Cerebral Perfusion Pressure After Traumatic Brain Injury: A CENTER-TBI Study

Author

Birg T., Ortolano F., Wiegers E. J. A., Smielewski P., Savchenko Y., Ianosi B. A., Helbok R., Rossi S., Carbonara M., Zoerle T., Stocchetti N., Anke A., Beer R., Bellander B. -M., Beqiri E., Buki A., Cabeleira M., Chieregato A., Citerio G., Clusmann H., Czeiter E., Czosnyka M., Depreitere B., Ercole A., Frisvold S., Jankowski S., Kondziella D., Koskinen L. -O., Kowark A., Menon D. K., Meyfroidt G., Moeller K., Nelson D., Piippo-Karjalainen A., Radoi A., Ragauskas A., Raj R., Rhodes J., Rocka S., Rossaint R., Sahuquillo J., Sakowitz O., Sundstrom N., Takala R., Tamosuitis T., Tenovuo O., Vajkoczy P., Vargiolu A., Vilcinis R., Wolf S., Younsi A., Zeiler F. A., Public Health, HUS Neurocenter, Clinicum, Helsinki University Hospital Area, Neurokirurgian yksikkö, Ragauskas, Arminas, Ročka, Saulius, Tamošuitis, Tomas, Vilcinis, Rimantas, Rocka, Saulius, Tamosuitis, Tomas, „Springer Nature' grupė, Anke, Audny, Beer, Ronny, Bellander, Bo-Michael, Beqiri, Erta, Buki, Andras, Cabeleira, Manuel, Chieregato, Arturo, Citerio, Giuseppe, Clusmann, Hans, Czeiter, Endre, Czosnyka, Marek, Depreitere, Bart, Ercole, Ari, Frisvold, Shirin, Jankowski, Stefan, Kondziella, Danile, Koskinen, Lars-Owe, Kowark, Ana, Menon, David K., Meyfroidt, Geert, Moeller, Kirsten, Nelson, David, Piippo-Karjalainen, Anna, Radoi, Andreea, Raj, Rahul, Rhodes, Jonathan, Rossaint, Rolf, Sahuquillo, Juan, Sakowitz, Oliver, Sundström, Nina, Takala, Riikka, Tenovuo, Olli, Vajkoczy, Peter, Vargiolu, Alessia, Wolf, Stefan, Younsi, Alexander, Zeiler, Frederick A., Stocchetti, Nino [0000-0003-3250-6834], Apollo - University of Cambridge Repository, Birg, T, Ortolano, F, Wiegers, E, Smielewski, P, Savchenko, Y, Ianosi, B, Helbok, R, Rossi, S, Carbonara, M, Zoerle, T, Stocchetti, N, Anke, A, Beer, R, Bellander, B, Beqiri, E, Buki, A, Cabeleira, M, Chieregato, A, Citerio, G, Clusmann, H, Czeiter, E, Czosnyka, M, Depreitere, B, Ercole, A, Frisvold, S, Jankowski, S, Kondziella, D, Koskinen, L, Kowark, A, Menon, D, Meyfroidt, G, Moeller, K, Nelson, D, Piippo-Karjalainen, A, Radoi, A, Ragauskas, A, Raj, R, Rhodes, J, Rocka, S, Rossaint, R, Sahuquillo, J, Sakowitz, O, Sundstrom, N, Takala, R, Tamosuitis, T, Tenovuo, O, Vajkoczy, P, Vargiolu, A, Vilcinis, R, Wolf, S, Younsi, A, and Zeiler, F

Subjects
Neurology, PYREXIA, Intracranial Pressure, MULTICENTER, GUIDELINES, Critical Care and Intensive Care Medicine, Neuromonitoring, 3124 Neurology and psychiatry, 0302 clinical medicine, Traumatic brain injury, Brain Injuries, Traumatic, brain temperature, cerebral perfusion pressure, fever, hyperthermia, intracranial pressure, neuromonitoring, traumatic brain injury, Longitudinal Studies, Prospective Studies, Intracranial pressure, WORSENS, Cerebral perfusion pressure, integumentary system, musculoskeletal, neural, and ocular physiology, CRITICAL-CARE, Temperature, Brain, Cerebrovascular Circulation, Cardiology, medicine.symptom, Life Sciences & Biomedicine, Original Work, Hyperthermia, medicine.medical_specialty, Fever, Clinical Neurology, HYPERTHERMIA, Brain damage, 03 medical and health sciences, Critical Care Medicine, Paired samples, General & Internal Medicine, Internal medicine, RECTAL TEMPERATURES, medicine, Humans, Clinical significance, HEAD, HYPOTHERMIA, Science & Technology, business.industry, 3112 Neurosciences, 030208 emergency & critical care medicine, medicine.disease, nervous system diseases, Brain temperature, Neurosciences & Neurology, Neurology (clinical), Intracranial Hypertension, business, 030217 neurology & neurosurgery
Abstract

Funder: Università degli Studi di Milano, BACKGROUND: After traumatic brain injury (TBI), fever is frequent. Brain temperature (BT), which is directly linked to body temperature, may influence brain physiology. Increased body and/or BT may cause secondary brain damage, with deleterious effects on intracranial pressure (ICP), cerebral perfusion pressure (CPP), and outcome. METHODS: Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI), a prospective multicenter longitudinal study on TBI in Europe and Israel, includes a high resolution cohort of patients with data sampled at a high frequency (from 100 to 500 Hz). In this study, simultaneous BT, ICP, and CPP recordings were investigated. A mixed-effects linear model was used to examine the association between different BT levels and ICP. We additionally focused on changes in ICP and CPP during the episodes of BT changes (Δ BT ≥ 0.5 °C lasting from 15 min to 3 h) up or downward. The significance of ICP and CPP variations was estimated with the paired samples Wilcoxon test (also known as Wilcoxon signed-rank test). RESULTS: Twenty-one patients with 2,435 h of simultaneous BT and ICP monitoring were studied. All patients reached a BT of 38 °C and experienced at least one episode of ICP above 20 mm Hg. The linear mixed-effects model revealed an association between BT above 37.5 °C and higher ICP levels that was not confirmed for lower BT. We identified 149 episodes of BT changes. During BT elevations (n = 79) ICP increased, whereas CPP was reduced; opposite ICP and CPP variations occurred during episodes of BT reduction (n = 70). All these changes were of moderate clinical relevance (increase of ICP of 4.5 and CPP decrease of 7.5 mm Hg for BT rise, and ICP reduction of 1.7 and CPP elevation of 3.7 mm Hg during BT defervescence), even if statistically significant (p < 0.0001). It has to be noted, however, that a number of therapeutic interventions against intracranial hypertension was documented during those episodes. CONCLUSIONS: Patients after TBI usually develop BT > 38 °C soon after the injury. BT may influence brain physiology, as reflected by ICP and CPP. An association between BT exceeding 37.5 °C and a higher ICP was identified but not confirmed for lower BT ranges. The relationship between BT, ICP, and CPP become clearer during rapid temperature changes. During episodes of temperature elevation, BT seems to have a significant impact on ICP and CPP.

Published
2021

2. Prediction model for intracranial hypertension demonstrates robust performance during external validation on the CENTER-TBI dataset

Author

Carra G., Guiza F., Depreitere B., Meyfroidt G., Anke A., Beer R., Bellander B. -M., Beqiri E., Buki A., Cabeleira M., Carbonara M., Chieregato A., Citerio G., Clusmann H., Czeiter E., Czosnyka M., Ercole A., Frisvold S., Helbok R., Jankowski S., Kondziella D., Koskinen L. -O., Kowark A., Menon D. K., Moeller K., Nelson D., Piippo-Karjalainen A., Radoi A., Ragauskas A., Raj R., Rhodes J., Rocka S., Rossaint R., Sahuquillo J., Sakowitz O., Smielewski P., Stocchetti N., Sundstrom N., Takala R., Tenovuo O., Vajkoczy P., Vargiolu A., Vilcinis R., Wolf S., Younsi A., Zeiler F. A., Carra, G, Guiza, F, Depreitere, B, Meyfroidt, G, Anke, A, Beer, R, Bellander, B, Beqiri, E, Buki, A, Cabeleira, M, Carbonara, M, Chieregato, A, Citerio, G, Clusmann, H, Czeiter, E, Czosnyka, M, Ercole, A, Frisvold, S, Helbok, R, Jankowski, S, Kondziella, D, Koskinen, L, Kowark, A, Menon, D, Moeller, K, Nelson, D, Piippo-Karjalainen, A, Radoi, A, Ragauskas, A, Raj, R, Rhodes, J, Rocka, S, Rossaint, R, Sahuquillo, J, Sakowitz, O, Smielewski, P, Stocchetti, N, Sundstrom, N, Takala, R, Tenovuo, O, Vajkoczy, P, Vargiolu, A, Vilcinis, R, Wolf, S, Younsi, A, and Zeiler, F

Subjects
medicine.medical_specialty, business.industry, intracranial hypertension, Anesthesiology, Pain medicine, Emergency medicine, MEDLINE, External validation, Humans, Medicine, Center (algebra and category theory), Critical Care and Intensive Care Medicine, business
Published
2020

3. Descriptive analysis of low versus elevated intracranial pressure on cerebral physiology in adult traumatic brain injury : a CENTER-TBI exploratory study

Author

Zeiler F. A., Ercole A., Cabeleira M., Stocchetti N., Hutchinson P. J., Smielewski P., Czosnyka M., Anke A., Beer R., Bellander B. -M., Beqiri E., Buki A., Carbonara M., Chieregato A., Citerio G., Clusmann H., Czeiter E., Depreitere B., Frisvold S., Helbok R., Jankowski S., Kondziella D., Koskinen L. -O., Kowark A., Menon D. K., Meyfroidt G., Moeller K., Nelson D., Piippo-Karjalainen A., Radoi A., Ragauskas A., Raj R., Rhodes J., Rocka S., Rossaint R., Sahuquillo J., Sakowitz O., Sundstrom N., Takala R., Tamosuitis T., Tenovuo O., Unterberg A., Vajkoczy P., Vargiolu A., Vilcinis R., Wolf S., Younsi A., HUS Neurocenter, Helsinki University Hospital Area, Neurokirurgian yksikkö, Zeiler, F, Ercole, A, Cabeleira, M, Stocchetti, N, Hutchinson, P, Smielewski, P, Czosnyka, M, Anke, A, Beer, R, Bellander, B, Beqiri, E, Buki, A, Carbonara, M, Chieregato, A, Citerio, G, Clusmann, H, Czeiter, E, Depreitere, B, Frisvold, S, Helbok, R, Jankowski, S, Kondziella, D, Koskinen, L, Kowark, A, Menon, D, Meyfroidt, G, Moeller, K, Nelson, D, Piippo-Karjalainen, A, Radoi, A, Ragauskas, A, Raj, R, Rhodes, J, Rocka, S, Rossaint, R, Sahuquillo, J, Sakowitz, O, Sundstrom, N, Takala, R, Tamosuitis, T, Tenovuo, O, Unterberg, A, Vajkoczy, P, Vargiolu, A, Vilcinis, R, Wolf, S, Younsi, A, Ragauskas, Arminas, Ročka, Saulius, Tamošuitis, Tomas, Vilcinis, Rimantas, and „Springer' grupė

Subjects
Male, Neurology, Intracranial Pressure, Neurologi, OXYGEN, 3124 Neurology and psychiatry, law.invention, 0302 clinical medicine, Cerebral physiology, Cerebrovascular reactivity, ICP extremes, Outcomes, law, Brain Injuries, Traumatic, Medicine, 030212 general & internal medicine, INDEX, Neuroradiology, Outcome, integumentary system, musculoskeletal, neural, and ocular physiology, Brain, CEREBROVASCULAR REACTIVITY, Middle Aged, AUTOREGULATION, Intensive care unit, humanities, Cerebrovascular Circulation, Cohort, Cardiology, Female, Neurosurgery, Life Sciences & Biomedicine, Adult, medicine.medical_specialty, Traumatic brain injury, Clinical Neurology, CLASSIFICATION, 03 medical and health sciences, Original Article - Brain trauma, Internal medicine, MANAGEMENT, Humans, Cerebral perfusion pressure, Aged, Retrospective Studies, Science & Technology, business.industry, 3112 Neurosciences, Oxygenation, medicine.disease, 3126 Surgery, anesthesiology, intensive care, radiology, nervous system diseases, ICP extreme, Surgery, Neurology (clinical), Neurosciences & Neurology, Intracranial Hypertension, business, 030217 neurology & neurosurgery
Abstract

Background To date, the cerebral physiologic consequences of persistently elevated intracranial pressure (ICP) have been based on either low-resolution physiologic data or retrospective high-frequency data from single centers. The goal of this study was to provide a descriptive multi-center analysis of the cerebral physiologic consequences of ICP, comparing those with normal ICP to those with elevated ICP. Methods The Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) High-Resolution Intensive Care Unit (HR-ICU) sub-study cohort was utilized. The first 3 days of physiologic recording were analyzed, evaluating and comparing those patients with mean ICP 20 mmHg. Various cerebral physiologic parameters were derived and evaluated, including ICP, brain tissue oxygen (PbtO2), cerebral perfusion pressure (CPP), pulse amplitude of ICP (AMP), cerebrovascular reactivity, and cerebral compensatory reserve. The percentage time and dose above/below thresholds were also assessed. Basic descriptive statistics were employed in comparing the two cohorts. Results 185 patients were included, with 157 displaying a mean ICP below 15 mmHg and 28 having a mean ICP above 20 mmHg. For admission demographics, only admission Marshall and Rotterdam CT scores were statistically different between groups (p = 0.017 and p = 0.030, respectively). The high ICP group displayed statistically worse CPP, PbtO2, cerebrovascular reactivity, and compensatory reserve. The high ICP group displayed worse 6-month mortality (p p = 0.014), based on the Extended Glasgow Outcome Score. Conclusions Low versus high ICP during the first 72 h after moderate/severe TBI is associated with significant disparities in CPP, AMP, cerebrovascular reactivity, cerebral compensatory reserve, and brain tissue oxygenation metrics. Such ICP extremes appear to be strongly related to 6-month patient outcomes, in keeping with previous literature. This work provides multi-center validation for previously described single-center retrospective results.

Published
2020

4. Association between Cerebrovascular Reactivity Monitoring and Mortality Is Preserved When Adjusting for Baseline Admission Characteristics in Adult Traumatic Brain Injury: A CENTER-TBI Study

Author

Zeiler, F.A., Ercole, A., Beqiri, E., Cabeleira, M., Thelin, E.P., Stocchetti, N., Steyerberg, E.W., Maas, A.I.R., Menon, D.K., Czosnyka, M., Smielewski, P., Anke, A., Beer, R., Helbok, R., Bellander, B.M., Nelson, D., Buki, A., Chevallard, G., Chieregato, A., Citerio, G., Czeiter, E., Depreitere, B., Eapen, G., Frisvold, S., Jankowski, S., Kondziella, D., Koskinen, L.O., Meyfroidt, G., Moeller, K., Piippo-Karjalainen, A., Raj, R., Radoi, A., Sahuquillo, J., Ragauskas, A., Rocka, S., Rhodes, J., Rossaint, R., Stevanovic, A., Sakowitz, O., Sundstrom, N., Takala, R., Tamosuitis, T., Tenovuo, O., Vajkoczy, P., Vargiolu, A., Vilcinis, R., Wolf, S., Younsi, A., CTR-TBI High Resolution ICU HR ICU, Public Health, CTR-TBI High Resolution ICU HR ICU, Zeiler, F, Ercole, A, Beqiri, E, Cabeleira, M, Thelin, E, Stocchetti, N, Steyerberg, E, Maas, A, Menon, D, Czosnyka, M, Smielewski, P, and Citerio, G

Subjects
autoregulation, cerebrovascular reactivity, IMPACT, outcome analysis, Adult, Male, 030506 rehabilitation, medicine.medical_specialty, Neurology, Traumatic brain injury, IMPACT, Cerebral autoregulation, cerebrovascular reactivity, Cohort Studies, outcome analysi, 03 medical and health sciences, 0302 clinical medicine, Cerebrovascular reactivity, Patient Admission, outcome analysis, Brain Injuries, Traumatic, medicine, Humans, Autoregulation, Single-Blind Method, Prospective Studies, Mortality, Adult patients, business.industry, autoregulation, Original Articles, Middle Aged, medicine.disease, 3. Good health, Pressure reactivity, Anesthesia, Cerebrovascular Circulation, Female, Human medicine, Neurology (clinical), Neurosurgery, 0305 other medical science, business, 030217 neurology & neurosurgery
Abstract

Cerebral autoregulation, as measured using the pressure reactivity index (PRx), has been related to global patient outcome in adult patients with traumatic brain injury (TBI). To date, this has been documented without accounting for standard baseline admission characteristics and intracranial pressure (ICP). We evaluated this association, adjusting for baseline admission characteristics and ICP, in a multi-center, prospective cohort. We derived PRx as the correlation between ICP and mean arterial pressure in prospectively collected multi-center data from the High-Resolution Intensive Care Unit (ICU) cohort of the Collaborative European NeuroTrauma Effectiveness Research in TBI (CENTER-TBI) study. Multi-variable logistic regression models were analyzed to assess the association between global outcome (measured as either mortality or dichotomized Glasgow Outcome Score-Extended [GOSE]) and a range of covariates (IMPACT [International Mission for Prognosis and Analysis of Clinical Trials] Core and computed tomography [CT] variables, ICP, and PRx). Performance of these models in outcome association was compared using area under the receiver operating curve (AUC) and Nagelkerke's pseudo-R-2. One hundred ninety-three patients had a complete data set for analysis. The addition of percent time above threshold for PRx improved AUC and displayed statistically significant increases in Nagelkerke's pseudo-R-2 over the IMPACT Core and IMPACT Core + CT models for mortality. The addition of PRx monitoring to IMPACT Core +/- CT + ICP models accounted for additional variance in mortality, when compared to models with IMPACT Core +/- CT + ICP alone. The addition of cerebrovascular reactivity monitoring, through PRx, provides a statistically significant increase in association with mortality at 6 months. Our data suggest that cerebrovascular reactivity monitoring may provide complementary information regarding outcomes in TBI.

Published
2019

5. Evaluation of the relationship between slow-waves of intracranial pressure, mean arterial pressure and brain tissue oxygen in TBI: a CENTER-TBI exploratory analysis

Author

Zeiler, Frederick A., Cabeleira, Manuel, Bellander, Bo-Michael, Beqiri, Erta, Buki, Andras, Carbonara, Marco, Chieregato, Arturo, Citerio, Giuseppe, Clusmann, Hans, Czeiter, Endre, Czosnyka, Marek, Hutchinson, Peter J., Depreitere, Bart, Ercole, Ari, Frisvold, Shirin, Helbok, Raimund, Jankowski, Stefan, Kondziella, Danile, Koskinen, Lars-Owe, Kowark, Ana, Menon, David K., Meyfroidt, Geert, Stocchetti, Nino, Moeller, Kirsten, Nelson, David, Piippo-Karjalainen, Anna, Radoi, Andreea, Ragauskas, Arminas, Raj, Rahul, Rhodes, Jonathan, Rocka, Saulius, Rossaint, Rolf, Sahuquillo, Juan, Sakowitz, Oliver, Smielewski, Peter, Sundström, Nina, Takala, Riikka, Tamosuitis, Tomas, Tenovuo, Olli, Vajkoczy, Peter, Vargiolu, Alessia, Vilcinis, Rimantas, Wolf, Stefan, Younsi, Alexander, CENTER-TBI High-Resolution ICU (HR ICU) Sub-Study Participants and Investigators, Audny, Anke, Beer, Ronny, Ragauskas, Arminas, Rocka, Saulius, Tamosuitis, Tomas, Vilcinis, Rimantas, „Springer' grupė, Ročka, Saulius, Tamošuitis, Tomas, Zeiler, Frederick A. [0000-0003-1737-0510], Stocchetti, Nino [0000-0003-3250-6834], Apollo - University of Cambridge Repository, Zeiler, F, Cabeleira, M, Hutchinson, P, Stocchetti, N, Czosnyka, M, Smielewski, P, Ercole, A, Anke, A, Beer, R, Bellander, B, Beqiri, E, Buki, A, Carbonara, M, Chieregato, A, Citerio, G, Clusmann, H, Czeiter, E, Depreitere, B, Frisvold, S, Helbok, R, Jankowski, S, Kondziella, D, Koskinen, L, Kowark, A, Menon, D, Meyfroidt, G, Moeller, K, Nelson, D, Piippo-Karjalainen, A, Radoi, A, Ragauskas, A, Raj, R, Rhodes, J, Rocka, S, Rossaint, R, Sahuquillo, J, Sakowitz, O, Sundstrom, N, Takala, R, Tamosuitis, T, Tenovuo, O, Vajkoczy, P, Vargiolu, A, Vilcinis, R, Wolf, S, Younsi, A, HUS Neurocenter, Clinicum, Helsinki University Hospital Area, and Neurokirurgian yksikkö

Subjects
Intracranial Pressure, Neurologi, CEREBRAL AUTOREGULATION, FLOW, Critical Care and Intensive Care Medicine, 3124 Neurology and psychiatry, CONSENSUS CONFERENCE, LOWER LIMIT, 0302 clinical medicine, Traumatic brain injury, Anesthesiology, Brain Injuries, Traumatic, TBI, Autoregulation, Cerebrovascular reactivity, Autoregressive integrated moving average, PART II, Intracranial pressure, Original Research, traumatic brain injury, autoregulation, Brain, Autoregressive model, Neurology, Cerebrovascular Circulation, Cardiology, brain tissue oxygen, cerebrovascular reactivity, Life Sciences & Biomedicine, medicine.medical_specialty, Mean arterial pressure, Brain tissue oxygen, INDEXES, Health Informatics, Cerebral autoregulation, CLASSIFICATION, 03 medical and health sciences, Internal medicine, medicine, INJURY, MANAGEMENT, Humans, Arterial Pressure, Science & Technology, business.industry, 3112 Neurosciences, 030208 emergency & critical care medicine, medicine.disease, nervous system diseases, Oxygen, Anesthesiology and Pain Medicine, Blood pressure, business, 030217 neurology & neurosurgery
Abstract

Journal of clinical monitoring and computing 35(4), 711-722 (2021). doi:10.1007/s10877-020-00527-6, Published by Springer Science + Business Media B.V., Dordrecht [u.a.]

Published
2021

6. Modeling Brain-Heart Crosstalk Information in Patients with Traumatic Brain Injury

Author

Peter Smielewski, Erta Beqiri, Ari Ercole, Giovanna Maria Dimitri, Pietro Liò, Michał M. Placek, Nino Stocchetti, Marek Czosnyka, HUS Neurocenter, Clinicum, Helsinki University Hospital Area, Neurokirurgian yksikkö, Ragauskas, Arminas, Rocka, Saulius, Tamosuitis, Tomas, Vilcinis, Rimantas, „Springer' grupė, Dimitri, G, Beqiri, E, Placek, M, Czosnyka, M, Stocchetti, N, Ercole, A, Smielewski, P, Lió, P, Citerio, G, Ročka, Saulius, Tamošuitis, Tomas, Dimitri, Giovanna Maria [0000-0002-2728-4272], Lio, Pietro [0000-0002-0540-5053], and Apollo - University of Cambridge Repository

Subjects
Adult, medicine.medical_specialty, Adolescent, Intracranial Pressure, Traumatic brain injury, Intracranial pressure, CENTER-TBI, Critical Care and Intensive Care Medicine, Logistic regression, Standard deviation, 3124 Neurology and psychiatry, Cohort Studies, Young Adult, Heart Rate, Internal medicine, Heart rate, REGRESSION, Brain Injuries, Traumatic, medicine, MANAGEMENT, Humans, Raised heart rate, CENTER-TBI Collaborators, Aged, Monitoring, Physiologic, Aged, 80 and over, business.industry, Confounding, 3112 Neurosciences, Raised intracranial pressure, Brain, Heart, CARE, Middle Aged, medicine.disease, Point-biserial correlation coefficient, Cohort, Cardiology, Neurology (clinical), business
Abstract

Funder: Università degli Studi di Siena, BACKGROUND: Traumatic brain injury (TBI) is an extremely heterogeneous and complex pathology that requires the integration of different physiological measurements for the optimal understanding and clinical management of patients. Information derived from intracranial pressure (ICP) monitoring can be coupled with information obtained from heart rate (HR) monitoring to assess the interplay between brain and heart. The goal of our study is to investigate events of simultaneous increases in HR and ICP and their relationship with patient mortality.. METHODS: In our previous work, we introduced a novel measure of brain-heart interaction termed brain-heart crosstalks (ctnp), as well as two additional brain-heart crosstalks indicators [mutual information ([Formula: see text]) and average edge overlap (ωct)] obtained through a complex network modeling of the brain-heart system. These measures are based on identification of simultaneous increase of HR and ICP. In this article, we investigated the relationship of these novel indicators with respect to mortality in a multicenter TBI cohort, as part of the Collaborative European Neurotrauma Effectiveness Research in TBI high-resolution work package. RESULTS: A total of 226 patients with TBI were included in this cohort. The data set included monitored parameters (ICP and HR), as well as laboratory, demographics, and clinical information. The number of detected brain-heart crosstalks varied (mean 58, standard deviation 57). The Kruskal-Wallis test comparing brain-heart crosstalks measures of survivors and nonsurvivors showed statistically significant differences between the two distributions (p values: 0.02 for [Formula: see text], 0.005 for ctnp and 0.006 for ωct). An inverse correlation was found, computed using the point biserial correlation technique, between the three new measures and mortality: - 0.13 for ctnp (p value 0.04), - 0.19 for ωct (p value 0.002969) and - 0.09 for [Formula: see text] (p value 0.1396). The measures were then introduced into the logistic regression framework, along with a set of input predictors made of clinical, demographic, computed tomography (CT), and lab variables. The prediction models were obtained by dividing the original cohort into four age groups (16-29, 30-49, 50-65, and 65-85 years of age) to properly treat with the age confounding factor. The best performing models were for age groups 16-29, 50-65, and 65-85, with the deviance of ratio explaining more than 80% in all the three cases. The presence of an inverse relationship between brain-heart crosstalks and mortality was also confirmed. CONCLUSIONS: The presence of a negative relationship between mortality and brain-heart crosstalks indicators suggests that a healthy brain-cardiovascular interaction plays a role in TBI.

Published
2020

7. Low-resolution pressure reactivity index and its derived optimal cerebral perfusion pressure in adult traumatic brain injury: a CENTER-TBI study

Author

Riemann, Lennart, Beqiri, Erta, Smielewski, Peter, Czosnyka, Marek, Stocchetti, Nino, Sakowitz, Oliver, Zweckberger, Klaus, Unterberg, Andreas, Younsi, Alexander, Anke, Audny, Beer, Ronny, Bellander, Bo-Michael, Buki, Andras, Chevallard, Giorgio, Chieregato, Arturo, Citerio, Giuseppe, Czeiter, Endre, Depreitere, Bart, Eapen, George, Frisvold, Shirin, Helbok, Raimund, Jankowski, Stefan, Kondziella, Daniel, Koskinen, Lars-Owe, Meyfroidt, Geert, Moeller, Kirsten, Nelson, David, Piippo-Karjalainen, Anna, Radoi, Andreea, Ragauskas, Arminas, Raj, Rahul, Rhodes, Jonathan, Rocka, Saulius, Rossaint, Rolf, Sahuquillo, Juan, Stevanovic, Ana, Sundström, Nina, Takala, Riikka, Tamosuitis, Tomas, Tenovuo, Olli, Vajkoczy, Peter, Vargiolu, Alessia, Vilcinis, Rimantas, Wolf, Stefan, Younsi, Alexander [0000-0002-8218-9243], Apollo - University of Cambridge Repository, Ragauskas, Arminas, Rocka, Saulius, Tamosuitis, Tomas, Vilcinis, Rimantas, „Springer' grupė, Ročka, Saulius, Tamošuitis, Tomas, Riemann, L, Beqiri, E, Smielewski, P, Czosnyka, M, Stocchetti, N, Sakowitz, O, Zweckberger, K, Unterberg, A, Younsi, A, Anke, A, Beer, R, Bellander, B, Buki, A, Chevallard, G, Chieregato, A, Citerio, G, Czeiter, E, Depreitere, B, Eapen, G, Frisvold, S, Helbok, R, Jankowski, S, Kondziella, D, Koskinen, L, Meyfroidt, G, Moeller, K, Nelson, D, Piippo-Karjalainen, A, Radoi, A, Ragauskas, A, Raj, R, Rhodes, J, Rocka, S, Rossaint, R, Sahuquillo, J, Stevanovic, A, Sundstrom, N, Takala, R, Tamosuitis, T, Tenovuo, O, Vajkoczy, P, Vargiolu, A, Vilcinis, R, and Wolf, S

Subjects
Adult, Male, medicine.medical_specialty, Multivariate statistics, Multivariate analysis, Neurologi, INTRACRANIAL-PRESSURE, Traumatic brain injury, Critical Care and Intensive Care Medicine, Cerebral autoregulation, 03 medical and health sciences, 0302 clinical medicine, Critical Care Medicine, General & Internal Medicine, Internal medicine, Brain Injuries, Traumatic, MANAGEMENT, medicine, Humans, Cerebrovascular reactivity, 030212 general & internal medicine, Cerebral perfusion pressure, Aged, Retrospective Studies, Intracranial pressure, CPPopt, Science & Technology, business.industry, Research, lcsh:Medical emergencies. Critical care. Intensive care. First aid, Univariate, lcsh:RC86-88.9, Middle Aged, medicine.disease, Intensive Care Units, Blood pressure, Neurology, Cerebrovascular Circulation, Cardiology, Female, business, Life Sciences & Biomedicine, 030217 neurology & neurosurgery
Abstract

Background After traumatic brain injury (TBI), brain tissue can be further damaged when cerebral autoregulation is impaired. Managing cerebral perfusion pressure (CPP) according to computed “optimal CPP” values based on cerebrovascular reactivity indices might contribute to preventing such secondary injuries. In this study, we examined the discriminative value of a low-resolution long pressure reactivity index (LPRx) and its derived “optimal CPP” in comparison to the well-established high-resolution pressure reactivity index (PRx). Methods Using the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study dataset, the association of LPRx (correlation between 1-min averages of intracranial pressure and arterial blood pressure over a moving time frame of 20 min) and PRx (correlation between 10-s averages of intracranial pressure and arterial blood pressure over a moving time frame of 5 min) to outcome was assessed and compared using univariate and multivariate regression analysis. “Optimal CPP” values were calculated using a multi-window algorithm that was based on either LPRx or PRx, and their discriminative ability was compared. Results LPRx and PRx were both significant predictors of mortality in univariate and multivariate regression analysis, but PRx displayed a higher discriminative ability. Similarly, deviations of actual CPP from “optimal CPP” values calculated from each index were significantly associated with outcome in univariate and multivariate analysis. “Optimal CPP” based on PRx, however, trended towards more precise predictions. Conclusions LPRx and its derived “optimal CPP” which are based on low-resolution data were significantly associated with outcome after TBI. However, they did not reach the discriminative ability of the high-resolution PRx and its derived “optimal CPP.” Nevertheless, LPRx might still be an interesting tool to assess cerebrovascular reactivity in centers without high-resolution signal monitoring. Trial registration ClinicalTrials.gov Identifier: NCT02210221. First submitted July 29, 2014. First posted August 6, 2014.

Published
2020
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8. Quality indicators for patients with traumatic brain injury in European intensive care units: A CENTER-TBI study

Author

Huijben, Jilske A., Wiegers, Eveline J. A., Ercole, Ari, De Keizer, Nicolette F., Maas, Andrew I. R., Steyerberg, Ewout W., Citerio, Giuseppe, Wilson, Lindsay, Polinder, Suzanne, Nieboer, Daan, Menon, David, Lingsma, Hester F., Van Der Jagt, Mathieu, Åkerlund, Cecilia, Amrein, Krisztina, Andelic, Nada, Andreassen, Lasse, Audibert, Gérard, Azouvi, Philippe, Azzolini, Maria Luisa, Bartels, Ronald, Beer, Ronny, Bellander, Bo-Michael, Benali, Habib, Berardino, Maurizio, Beretta, Luigi, Beqiri, Erta, Blaabjerg, Morten, Lund, Stine Borgen, Brorsson, Camilla, Buki, Andras, Cabeleira, Manuel, Caccioppola, Alessio, Calappi, Emiliana, Calvi, Maria Rosa, Cameron, Peter, Lozano, Guillermo Carbayo, Carbonara, Marco, Castaño-León, Ana M., Cavallo, Simona, Chevallard, Giorgio, Chieregato, Arturo, Coburn, Mark, Coles, Jonathan, Cooper, Jamie D., Correia, Marta, Czeiter, Endre, Czosnyka, Marek, Dahyot-Fizelier, Claire, Dark, Paul, De Keyser, Véronique, Degos, Vincent, Corte, Francesco Della, Den Boogert, Hugo, Depreitere, Bart, Dilvesi, Dula, Dixit, Abhishek, Dreier, Jens, Dulière, Guy-Loup, Ezer, Erzsébet, Fabricius, Martin, Foks, Kelly, Frisvold, Shirin, Furmanov, Alex, Galanaud, Damien, Gantner, Dashiell, Ghuysen, Alexandre, Giga, Lelde, Golubovic, Jagos, Gomez, Pedro A., Grossi, Francesca, Gupta, Deepak, Haitsma, Iain, Helbok, Raimund, Helseth, Eirik, Hutchinson, Peter J., Jankowski, Stefan, Johnson, Faye, Karan, Mladen, Kolias, Angelos G., Kondziella, Daniel, Koraropoulos, Evgenios, Koskinen, Lars-Owe, Kovács, Noémi, Kowark, Ana, Lagares, Alfonso, Laureys, Steven, Lecky, Fiona, Ledoux, Didier, Lejeune, Aurelie, Lightfoot, Roger, Manara, Alex, Martino, Costanza, Maréchal, Hugues, Mattern, Julia, McMahon, Catherine, Menovsky, Tomas, Misset, Benoit, Muraleedharan, Visakh, Murray, Lynnette, Negru, Ancuta, Nelson, David, Newcombe, Virginia, Nyirádi, József, Ortolano, Fabrizio, Payen, Jean-François, Perlbarg, Vincent, Persona, Paolo, Peul, Wilco, Piippo-Karjalainen, Anna, Ples, Horia, Pomposo, Inigo, Posti, Jussi P., Puybasset, Louis, Radoi, Andreea, Ragauskas, Arminas, Raj, Rahul, Rhodes, Jonathan, Richter, Sophie, Rocka, Saulius, Roe, Cecilie, Roise, Olav, Rosenfeld, Jeffrey V., Rosenlund, Christina, Rosenthal, Guy, Rossaint, Rolf, Rossi, Sandra, Sahuquillo, Juan, Sandrød, Oddrun, Sakowitz, Oliver, Sanchez-Porras, Renan, Schirmer-Mikalsen, Kari, Schou, Rico Frederik, Smielewski, Peter, Sorinola, Abayomi, Stamatakis, Emmanuel, Stocchetti, Nino, Sundström, Nina, Takala, Riikka, Tamás, Viktória, Tamosuitis, Tomas, Tenovuo, Olli, Thomas, Matt, Tibboel, Dick, Tolias, Christos, Trapani, Tony, Tudora, Cristina Maria, Vajkoczy, Peter, Vallance, Shirley, Valeinis, Egils, Vámos, Zoltán, Van Der Steen, Gregory, Van Dijck, Jeroen T. J. M., Van Essen, Thomas A., Van Wijk, Roel P. J., Vargiolu, Alessia, Vega, Emmanuel, Vik, Anne, Vilcinis, Rimantas, Volovici, Victor, Voormolen, Daphne, Vulekovic, Petar, Williams, Guy, Winzeck, Stefan, Wolf, Stefan, Younsi, Alexander, Zeiler, Frederick A., Ziverte, Agate, Zoerle, Tommaso, Clusmann, Hans, Huijben, J. A., Wiegers, E. J. A., Ercole, A., De Keizer, N. F., Maas, A. I. R., Steyerberg, E. W., Citerio, G., Wilson, L., Polinder, S., Nieboer, D., Menon, D., Lingsma, H. F., Van Der Jagt, M., Akerlund, C., Amrein, K., Andelic, N., Andreassen, L., Audibert, G., Azouvi, P., Azzolini, M. L., Bartels, R., Beer, R., Bellander, B. -M., Benali, H., Berardino, M., Beretta, L., Beqiri, E., Blaabjerg, M., Lund, S. B., Brorsson, C., Buki, A., Cabeleira, M., Caccioppola, A., Calappi, E., Calvi, M. R., Cameron, P., Lozano, G. C., Carbonara, M., Castano-Leon, A. M., Cavallo, S., Chevallard, G., Chieregato, A., Coburn, M., Coles, J., Cooper, J. D., Correia, M., Czeiter, E., Czosnyka, M., Dahyot-Fizelier, C., Dark, P., De Keyser, V., Degos, V., Corte, F. D., Den Boogert, H., Depreitere, B., Dilvesi, D., Dixit, A., Dreier, J., Duliere, G. -L., Ezer, E., Fabricius, M., Foks, K., Frisvold, S., Furmanov, A., Galanaud, D., Gantner, D., Ghuysen, A., Giga, L., Golubovic, J., Gomez, P. A., Grossi, F., Gupta, D., Haitsma, I., Helbok, R., Helseth, E., Hutchinson, P. J., Jankowski, S., Johnson, F., Karan, M., Kolias, A. G., Kondziella, D., Koraropoulos, E., Koskinen, L. -O., Kovacs, N., Kowark, A., Lagares, A., Laureys, S., Lecky, F., Ledoux, D., Lejeune, A., Lightfoot, R., Manara, A., Martino, C., Marechal, H., Mattern, J., Mcmahon, C., Menovsky, T., Misset, B., Muraleedharan, V., Murray, L., Negru, A., Nelson, D., Newcombe, V., Nyiradi, J., Ortolano, F., Payen, J. -F., Perlbarg, V., Persona, P., Peul, W., Piippo-Karjalainen, A., Ples, H., Pomposo, I., Posti, J. P., Puybasset, L., Radoi, A., Ragauskas, A., Raj, R., Rhodes, J., Richter, S., Rocka, S., Roe, C., Roise, O., Rosenfeld, J. V., Rosenlund, C., Rosenthal, G., Rossaint, R., Rossi, S., Sahuquillo, J., Sandrod, O., Sakowitz, O., Sanchez-Porras, R., Schirmer-Mikalsen, K., Schou, R. F., Smielewski, P., Sorinola, A., Stamatakis, E., Stocchetti, N., Sundstrom, N., Takala, R., Tamas, V., Tamosuitis, T., Tenovuo, O., Thomas, M., Tibboel, D., Tolias, C., Trapani, T., Tudora, C. M., Vajkoczy, P., Vallance, S., Valeinis, E., Vamos, Z., Van Der Steen, G., Van Dijck, J. T. J. M., Van Essen, T. A., Van Wijk, R. P. J., Vargiolu, A., Vega, E., Vik, A., Vilcinis, R., Volovici, V., Voormolen, D., Vulekovic, P., Williams, G., Winzeck, S., Wolf, S., Younsi, A., Zeiler, F. A., Ziverte, A., Zoerle, T., Clusmann, H., Ragauskas, Arminas, Ročka, Saulius, Tamošuitis, Tomas, Vilcinis, Rimantas, Rocka, Saulius, Tamosuitis, Tomas, „Springer' grupė, Public Health, Neurosurgery, Intensive Care, Huijben, J, Wiegers, E, Ercole, A, de Keizer, N, Maas, A, Steyerberg, E, Citerio, G, Wilson, L, Polinder, S, Nieboer, D, Menon, D, Lingsma, H, van der Jagt, M, Huijben, Jilske A. [0000-0002-2892-5406], Citerio, Giuseppe [0000-0002-5374-3161], Apollo - University of Cambridge Repository, Huijben, Jilske A [0000-0002-2892-5406], Ercole, Ari [0000-0001-8350-8093], Medical Informatics, APH - Methodology, APH - Quality of Care, and APH - Digital Health

Subjects
Adult, Male, benchmarking, intensive care units, quality indicators, quality of health care, traumatic brain injuries, medicine.medical_specialty, Quality management, Traumatic brain injury, Quality indicator, Quality indicators, Critical Care and Intensive Care Medicine, Traumatic brain injuries, 03 medical and health sciences, 0302 clinical medicine, Intensive care, Brain Injuries, Traumatic, medicine, Humans, Intensive care unit, 030212 general & internal medicine, Quality Indicators, Health Care, Intensive care units, business.industry, Data Collection, Research, lcsh:Medical emergencies. Critical care. Intensive care. First aid, Quality measurement, Regression analysis, lcsh:RC86-88.9, Odds ratio, Middle Aged, medicine.disease, Random effects model, Quality Improvement, Europe, Benchmarking, Emergency medicine, Quality of health care, Female, Human medicine, business, 030217 neurology & neurosurgery
Abstract

Background The aim of this study is to validate a previously published consensus-based quality indicator set for the management of patients with traumatic brain injury (TBI) at intensive care units (ICUs) in Europe and to study its potential for quality measurement and improvement. Methods Our analysis was based on 2006 adult patients admitted to 54 ICUs between 2014 and 2018, enrolled in the CENTER-TBI study. Indicator scores were calculated as percentage adherence for structure and process indicators and as event rates or median scores for outcome indicators. Feasibility was quantified by the completeness of the variables. Discriminability was determined by the between-centre variation, estimated with a random effect regression model adjusted for case-mix severity and quantified by the median odds ratio (MOR). Statistical uncertainty of outcome indicators was determined by the median number of events per centre, using a cut-off of 10. Results A total of 26/42 indicators could be calculated from the CENTER-TBI database. Most quality indicators proved feasible to obtain with more than 70% completeness. Sub-optimal adherence was found for most quality indicators, ranging from 26 to 93% and 20 to 99% for structure and process indicators. Significant (p Conclusions Overall, nine structures, five processes, but none of the outcome indicators showed potential for quality improvement purposes for TBI patients in the ICU. Future research should focus on implementation efforts and continuous reevaluation of quality indicators. Trial registration The core study was registered with ClinicalTrials.gov, number NCT02210221, registered on August 06, 2014, with Resource Identification Portal (RRID: SCR_015582).

Published
2020

9. Changing care pathways and between-center practice variations in intensive care for traumatic brain injury across Europe: a CENTER-TBI analysis

Author

Huijben, Jilske A., Wiegers, Eveline J. A., Lingsma, Hester F., Citerio, Giuseppe, Maas, Andrew I. R., Menon, David K., Ercole, Ari, Nelson, David, van der Jagt, Mathieu, Steyerberg, Ewout W., Helbok, Raimund, Lecky, Fiona, Peul, Wilco, Birg, Tatiana, Zoerle, Tommaso, Carbonara, Marco, Stocchetti, Nino, Åkerlund, Cecilia, Amrein, Krisztina, Andelic, Nada, Andreassen, Lasse, Audibert, Gérard, Azouvi, Philippe, Azzolini, Maria Luisa, Bartels, Ronald, Beer, Ronny, Bellander, Bo-Michael, Benali, Habib, Berardino, Maurizio, Beretta, Luigi, Beqiri, Erta, Blaabjerg, Morten, Lund, Stine Borgen, Brorsson, Camilla, Buki, Andras, Cabeleira, Manuel, Caccioppola, Alessio, Calappi, Emiliana, Calvi, Maria Rosa, Cameron, Peter, Lozano, Guillermo Carbayo, Castaño-León, Ana M., Cavallo, Simona, Chevallard, Giorgio, Chieregato, Arturo, Coburn, Mark, Coles, Jonathan, Cooper, Jamie D., Correia, Marta, Czeiter, Endre, Czosnyka, Marek, Dahyot-Fizelier, Claire, Dark, Paul, DeKeyser, Véronique, Degos, Vincent, Della Corte, Francesco, den Boogert, Hugo, Depreitere, Bart, Dilvesi, Dula, Dixit, Abhishek, Dreier, Jens, Dulière, Guy-Loup, Ezer, Erzsébet, Fabricius, Martin, Foks, Kelly, Frisvold, Shirin, Furmanov, Alex, Galanaud, Damien, Gantner, Dashiell, Ghuysen, Alexandre, Giga, Lelde, Golubovic, Jagos, Gomez, Pedro A., Grossi, Francesca, Gupta, Deepak, Haitsma, Iain, Helseth, Eirik, Hutchinson, Peter J., Jankowski, Stefan, Johnson, Faye, Karan, Mladen, Kolias, AngelosG., Kondziella, Daniel, Koraropoulos, Evgenios, Koskinen, Lars-Owe, Kovács, Noémi, Kowark, Ana, Lagares, Alfonso, Laureys, Steven, Ledoux, Didier, Lejeune, Aurelie, Lightfoot, Roger, Manara, Alex, Martino, Costanza, Maréchal, Hugues, Mattern, Julia, McMahon, Catherine, Menovsky, Tomas, Misset, Benoit, Muraleedharan, Visakh, Murray, Lynnette, Negru, Ancuta, Newcombe, Virginia, Nyirádi, József, Ortolano, Fabrizio, Payen, Jean-François, Perlbarg, Vincent, Persona, Paolo, Piippo-Karjalainen, Anna, Ples, Horia, Pomposo, Inigo, Posti, Jussi P., Puybasset, Louis, Radoi, Andreea, Ragauskas, Arminas, Raj, Rahul, Rhodes, Jonathan, Richter, Sophie, Rocka, Saulius, Roe, Cecilie, Roise, Olav, Rosenfeld, Jeffrey V., Rosenlund, Christina, Rosenthal, Guy, Rossaint, Rolf, Rossi, Sandra, Sahuquillo, Juan, Sandrød, Oddrun, Sakowitz, Oliver, Sanchez-Porras, Renan, Schirmer-Mikalsen, Kari, Schou, Rico Frederik, Smielewski, Peter, Sorinola, Abayomi, Stamatakis, Emmanuel, Sundström, Nina, Takala, Riikka, Tamás, Viktória, Tamosuitis, Tomas, Tenovuo, Olli, Thomas, Matt, Tibboel, Dick, Tolias, Christos, Trapani, Tony, Tudora, CristinaMaria, Vajkoczy, Peter, Vallance, Shirley, Valeinis, Egils, Vámos, Zoltán, Van der Steen, Gregory, van Wijk, Roel P. J., Vargiolu, Alessia, Vega, Emmanuel, Vik, Anne, Vilcinis, Rimantas, Volovici, Victor, Vulekovic, Petar, Williams, Guy, Winzeck, Stefan, Wolf, Stefan, Younsi, Alexander, Zeiler, Frederick A., Clusmann, Agate Ziverte Hans, Voormolen, Daphne, van Dijck, Jeroen T. J. M., van Essen, Thomas A., Ragauskas, Arminas, Ročka, Saulius, Tamošuitis, Tomas, Vilcinis, Rimantas, Tamosuitis, Tomas, „Springer' grupė, CTR-TBI Investigators Participants, Huijben, J, Wiegers, E, Lingsma, H, Citerio, G, Maas, A, Menon, D, Ercole, A, Nelson, D, van der Jagt, M, Steyerberg, E, Helbok, R, Lecky, F, Peul, W, Birg, T, Zoerle, T, Carbonara, M, Stocchetti, N, Huijben, Jilske A. [0000-0002-2892-5406], Apollo - University of Cambridge Repository, Huijben, Jilske A [0000-0002-2892-5406], Huijben, J. A., Wiegers, E. J. A., Lingsma, H. F., Citerio, G., Maas, A. I. R., Menon, D. K., Ercole, A., Nelson, D., van der Jagt, M., Steyerberg, E. W., Helbok, R., Lecky, F., Peul, W., Birg, T., Zoerle, T., Carbonara, M., Stocchetti, N., Akerlund, C., Amrein, K., Andelic, N., Andreassen, L., Audibert, G., Azouvi, P., Azzolini, M. L., Bartels, R., Beer, R., Bellander, B. -M., Benali, H., Berardino, M., Beretta, L., Beqiri, E., Blaabjerg, M., Lund, S. B., Brorsson, C., Buki, A., Cabeleira, M., Caccioppola, A., Calappi, E., Calvi, M. R., Cameron, P., Lozano, G. C., Castano-Leon, A. M., Cavallo, S., Chevallard, G., Chieregato, A., Coburn, M., Coles, J., Cooper, J. D., Correia, M., Czeiter, E., Czosnyka, M., Dahyot-Fizelier, C., Dark, P., Dekeyser, V., Degos, V., Della Corte, F., den Boogert, H., Depreitere, B., Dilvesi, D., Dixit, A., Dreier, J., Duliere, G. -L., Ezer, E., Fabricius, M., Foks, K., Frisvold, S., Furmanov, A., Galanaud, D., Gantner, D., Ghuysen, A., Giga, L., Golubovic, J., Gomez, P. A., Grossi, F., Gupta, D., Haitsma, I., Helseth, E., Hutchinson, P. J., Jankowski, S., Johnson, F., Karan, M., Kolias, A. G., Kondziella, D., Koraropoulos, E., Koskinen, L. -O., Kovacs, N., Kowark, A., Lagares, A., Laureys, S., Ledoux, D., Lejeune, A., Lightfoot, R., Manara, A., Martino, C., Marechal, H., Mattern, J., Mcmahon, C., Menovsky, T., Misset, B., Muraleedharan, V., Murray, L., Negru, A., Newcombe, V., Nyiradi, J., Ortolano, F., Payen, J. -F., Perlbarg, V., Persona, P., Piippo-Karjalainen, A., Ples, H., Pomposo, I., Posti, J. P., Puybasset, L., Radoi, A., Ragauskas, A., Raj, R., Rhodes, J., Richter, S., Rocka, S., Roe, C., Roise, O., Rosenfeld, J. V., Rosenlund, C., Rosenthal, G., Rossaint, R., Rossi, S., Sahuquillo, J., Sandrod, O., Sakowitz, O., Sanchez-Porras, R., Schirmer-Mikalsen, K., Schou, R. F., Smielewski, P., Sorinola, A., Stamatakis, E., Sundstrom, N., Takala, R., Tamas, V., Tamosuitis, T., Tenovuo, O., Thomas, M., Tibboel, D., Tolias, C., Trapani, T., Tudora, C. M., Vajkoczy, P., Vallance, S., Valeinis, E., Vamos, Z., Van der Steen, G., van Wijk, R. P. J., Vargiolu, A., Vega, E., Vik, A., Vilcinis, R., Volovici, V., Vulekovic, P., Williams, G., Winzeck, S., Wolf, S., Younsi, A., Zeiler, F. A., Clusmann, A. Z. H., Voormolen, D., van Dijck, J. T. J. M., van Essen, T. A., Public Health, and Intensive Care

Subjects
medicine.medical_specialty, Critical Care, Neurologi, Traumatic brain injury, Original, Intracranial pressure, Population, Critical Care and Intensive Care Medicine, Intensive care unit, Traumatic brain injury, Intracranial pressure, Outcome, law.invention, 03 medical and health sciences, 0302 clinical medicine, law, Intensive care, Anesthesiology, Brain Injuries, Traumatic, Medicine, Humans, Glasgow Coma Scale, Intensive care unit, Israel, education, Outcome, education.field_of_study, business.industry, 030208 emergency & critical care medicine, Odds ratio, Middle Aged, medicine.disease, 3. Good health, Europe, Intensive Care Units, 030228 respiratory system, Neurology, Emergency medicine, Human medicine, business
Abstract

Purpose: To describe ICU stay, selected management aspects, and outcome of Intensive Care Unit (ICU) patients with traumatic brain injury (TBI) in Europe, and to quantify variation across centers. Methods: This is a prospective observational multicenter study conducted across 18 countries in Europe and Israel. Admission characteristics, clinical data, and outcome were described at patient- and center levels. Between-center variation in the total ICU population was quantified with the median odds ratio (MOR), with correction for case-mix and random variation between centers. Results: A total of 2138 patients were admitted to the ICU, with median age of 49 years; 36% of which were mild TBI (Glasgow Coma Scale; GCS 13–15). Within, 72 h 636 (30%) were discharged and 128 (6%) died. Early deaths and long-stay patients (> 72 h) had more severe injuries based on the GCS and neuroimaging characteristics, compared with short-stay patients. Long-stay patients received more monitoring and were treated at higher intensity, and experienced worse 6-month outcome compared to short-stay patients. Between-center variations were prominent in the proportion of short-stay patients (MOR = 2.3, p

Published
2020

10. Diffuse Intracranial Injury Patterns Are Associated with Impaired Cerebrovascular Reactivity in Adult Traumatic Brain Injury: A CENTER-TBI Validation Study

Author

Frederick A. Zeiler, François Mathieu, Miguel Monteiro, Ben Glocker, Ari Ercole, Erta Beqiri, Manuel Cabeleira, Nino Stocchetti, Peter Smielewski, Marek Czosnyka, Virginia Newcombe, David K. Menon, Audny Anke, Bo-Michael Bellander, Andras Buki, Marco Carbonara, Arturo Chieregato, Giuseppe Citerio, Hans Clusmann, Endre Czeiter, Bart Depreitere, Shirin Frisvold, Raimund Helbok, Stefan Jankowski, Danile Kondziella, Lars-Owe Koskinen, Ana Kowark, Geert Meyfroidt, Kirsten Moeller, David Nelson, Anna Piippo-Karjalainen, Andreea Radoi, Arminas Ragauskas, Rahul Raj, Jonathan Rhodes, Saulius Rocka, Rolf Rossaint, Juan Sahuquillo, Oliver Sakowitz, Nina Sundström, Riikka Takala, Tomas Tamosuitis, Olli Tenovuo, Peter Vajkoczy, Alessia Vargiolu, Rimantas Vilcinis, Stefan Wolf, Alexander Younsi, Zeiler, F, Mathieu, F, Monteiro, M, Glocker, B, Ercole, A, Beqiri, E, Cabeleira, M, Stocchetti, N, Smielewski, P, Czosnyka, M, Newcombe, V, Menon, D, and Citerio, G

Subjects
Adult, Male, 030506 rehabilitation, medicine.medical_specialty, Validation study, Traumatic brain injury, injury pattern, Computed tomography, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, Cerebrovascular reactivity, Brain Injuries, Traumatic, medicine, Retrospective analysis, Humans, Autoregulation, Prospective Studies, image segmentation, medicine.diagnostic_test, business.industry, autoregulation, computed tomography, PRx, Original Articles, Middle Aged, medicine.disease, humanities, Cerebrovascular Circulation, Female, Neurology (clinical), Radiology, 0305 other medical science, business, Tomography, X-Ray Computed, 030217 neurology & neurosurgery, CT
Abstract

Recent single-center retrospective analysis displayed the association between admission computed tomography (CT) markers of diffuse intracranial injury and worse cerebrovascular reactivity. The goal of this study was to further explore these associations using the prospective multi-center Collaborative European Neurotrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) high-resolution intensive care unit (HR ICU) data set. Using the CENTER-TBI HR ICU sub-study cohort, we evaluated those patients with both archived high-frequency digital physiology (100 Hz or higher) and the presence of a digital admission CT scan. Physiological signals were processed for pressure reactivity index (PRx) and both the percent (%) time above defined PRx thresholds and mean hourly dose above threshold. Admission CT injury scores were obtained from the database. Quantitative contusion, edema, intraventricular hemorrhage (IVH), and extra-axial lesion volumes were obtained via semi-automated segmentation. Comparison between admission CT characteristics and PRx metrics was conducted using Mann-U, Jonckheere-Terpstra testing, with a combination of univariate linear and logistic regression techniques. A total of 165 patients were included. Cisternal compression and high admission Rotterdam and Helsinki CT scores, and Marshall CT diffuse injury sub-scores were associated with increased percent (%) time and hourly dose above PRx threshold of 0, +0.25, and +0.35 (p

Published
2020

11. Cerebrovascular reactivity is not associated with therapeutic intensity in adult traumatic brain injury : a CENTER-TBI analysis

Author

Zeiler, Frederick A., Ercole, Ari, Beqiri, Erta, Cabeleira, Manuel, Aries, Marcel, Zoerle, Tommaso, Carbonara, Marco, Stocchetti, Nino, Smielewski, Peter, Czosnyka, Marek, CENTER-TBI High Resolution ICU (HR ICU) Sub-Study Participants And Investigators, Menon, David K., Anke, Audny, Beer, Ronny, Bellander, Bo-Michael, Buki, Andras, Chevallard, Giorgio, Chieregato, Arturo, Citerio, Giuseppe, Czeiter, Endre, Depreitere, Bart, Eapen, George, Frisvold, Shirin, Helbok, Raimund, Jankowski, Stefan, Kondziella, Daniel, Koskinen, Lars-Owe, Meyfroidt, Geert, Moeller, Kirsten, Nelson, David, Piippo-Karjalainen, Anna, Radoi, Andreea, Ragauskas, Arminas, Raj, Rahul, Rhodes, Jonathan, Rocka, Saulius, Rossaint, Rolf, Sahuquillo, Juan, Sakowitz, Oliver, Stevanovic, Ana, Sundström, Nina, Takala, Riikka, Tamosuitis, Tomas, Tenovuo, Olli, Vajkoczy, Peter, Vargiolu, Alessia, Vilcinis, Rimantas, Wolf, Stefan, Younsi, Alexander, HUS Neurocenter, Department of Neurosciences, Neurokirurgian yksikkö, Staff Services, Helsinki University Hospital Area, Ragauskas, Arminas, Ročka, Saulius, Tamošuitis, Tomas, Vilcinis, Rimantas, Zeiler, Frederick A. [0000-0003-1737-0510], Apollo - University of Cambridge Repository, Zeiler, F, Ercole, A, Beqiri, E, Cabeleira, M, Aries, M, Zoerle, T, Carbonara, M, Stocchetti, N, Smielewski, P, Czosnyka, M, Menon, D, Anke, A, Beer, R, Bellander, B, Buki, A, Chevallard, G, Chieregato, A, Citerio, G, Czeiter, E, Depreitere, B, Eapen, G, Frisvold, S, Helbok, R, Jankowski, S, Kondziella, D, Koskinen, L, Meyfroidt, G, Moeller, K, Nelson, D, Piippo-Karjalainen, A, Radoi, A, Ragauskas, A, Raj, R, Rhodes, J, Rocka, S, Rossaint, R, Sahuquillo, J, Sakowitz, O, Stevanovic, A, Sundstrom, N, Takala, R, Tamosuitis, T, Tenovuo, O, Vajkoczy, P, Vargiolu, A, Vilcinis, R, Wolf, S, Younsi, A, Rocka, Saulius, Tamosuitis, Tomas, „Springer' grupė, Intensive Care, RS: MHeNs - R1 - Cognitive Neuropsychiatry and Clinical Neuroscience, and MUMC+: MA Medische Staf IC (9)

Subjects
Male, Neurology, Neurologi, cerebrovascular reactivity, PRx, TBI, therapeutic intensity, TIL, 3124 Neurology and psychiatry, 030218 nuclear medicine & medical imaging, Cohort Studies, 0302 clinical medicine, Brain Injuries, Traumatic, Cerebrovascular reactivity, Young adult, Neuroradiology, Therapeutic intensity, Middle Aged, AUTOREGULATION, ISOFLURANE, Treatment Outcome, CEREBRAL PERFUSION-PRESSURE, Cerebrovascular Circulation, Cardiology, Female, Neurosurgery, Life Sciences & Biomedicine, Cohort study, Adult, medicine.medical_specialty, Critical Care, Traumatic brain injury, Clinical Neurology, Cerebrovascular reactivity, PRx, TBI, Therapeutic intensity, TIL, Young Adult, 03 medical and health sciences, Original Article - Brain trauma, Brain trauma, Internal medicine, medicine, MANAGEMENT, Humans, Arterial Pressure, ddc:610, Aged, Retrospective Studies, SUPPRESSION, Science & Technology, business.industry, 3112 Neurosciences, Retrospective cohort study, medicine.disease, 3126 Surgery, anesthesiology, intensive care, radiology, Blood pressure, MODERATE HYPOTHERMIA, Surgery, Neurology (clinical), Neurosciences & Neurology, Intracranial Hypertension, business, 030217 neurology & neurosurgery
Abstract

Acta neurochirurgica 161(9), 1955-1964 (2019). doi:10.1007/s00701-019-03980-8, Published by Springer, Wien [u.a.]

Published
2019

12. Compensatory-reserve-weighted intracranial pressure versus intracranial pressure for outcome association in adult traumatic brain injury : a CENTER-TBI validation study

Author

Zeiler, Frederick A., Ercole, Ari, Cabeleira, Manuel, Beqiri, Erta, Zoerle, Tommaso, Carbonara, Marco, Stocchetti, Nino, Menon, David K., Smielewski, Peter, Czosnyka, Marek, Anke, Audny, Beer, Ronny, Bellander, Bo-Michael, Buki, Andras, Chevallard, Giorgio, Chieregato, Arturo, Citerio, Giuseppe, Czeiter, Endre, Depreitere, Bart, Eapen, George, Frisvold, Shirin, Helbok, Raimund, Jankowski, Stefan, Kondziella, Daniel, Koskinen, Lars-Owe, Meyfroidt, Geert, Moeller, Kirsten, Nelson, David, Piippo-Karjalainen, Anna, Radoi, Andreea, Ragauskas, Arminas, Raj, Rahul, Rhodes, Jonathan, Rocka, Saulius, Rossaint, Rolf, Sahuquillo, Juan, Sakowitz, Oliver, Stevanovic, Ana, Sundström, Nina, Takala, Riikka, Tamosuitis, Tomas, Tenovuo, Olli, Vajkoczy, Peter, Vargiolu, Alessia, Vilcinis, Rimantas, Wolf, Stefan, Younsi, Alexander, Ragauskas, Arminas, Ročka, Saulius, Tamošuitis, Tomas, Vilcinis, Rimantas, Zeiler, F, Ercole, A, Cabeleira, M, Beqiri, E, Zoerle, T, Carbonara, M, Stocchetti, N, Menon, D, Smielewski, P, Czosnyka, M, Anke, A, Beer, R, Bellander, B, Buki, A, Chevallard, G, Chieregato, A, Citerio, G, Czeiter, E, Depreitere, B, Eapen, G, Frisvold, S, Helbok, R, Jankowski, S, Kondziella, D, Koskinen, L, Meyfroidt, G, Moeller, K, Nelson, D, Piippo-Karjalainen, A, Radoi, A, Ragauskas, A, Raj, R, Rhodes, J, Rocka, S, Rossaint, R, Sahuquillo, J, Sakowitz, O, Stevanovic, A, Sundstrom, N, Takala, R, Tamosuitis, T, Tenovuo, O, Vajkoczy, P, Vargiolu, A, Vilcinis, R, Wolf, S, Younsi, A, Neurokirurgian yksikkö, Helsinki University Hospital Area, HUS Neurocenter, Rocka, Saulius, Tamosuitis, Tomas, „Springer' grupė, Zeiler, Frederick A. [0000-0003-1737-0510], and Apollo - University of Cambridge Repository

Subjects
Male, Neurologi, Logistic regression, 3124 Neurology and psychiatry, 030218 nuclear medicine & medical imaging, law.invention, 0302 clinical medicine, law, Brain Injuries, Traumatic, Weighted ICP, Intracranial pressure, Outcome, Univariate analysis, Area under the curve, Middle Aged, Intensive care unit, Intensive Care Units, compensatory reserve, intracranial pressure, outcome, weighted ICP, Neurology, Cohort, Cardiology, Female, Intracranial Pressure/physiology, Life Sciences & Biomedicine, Adult, medicine.medical_specialty, Compensatory reserve, Intracranial pressure, Outcome, Weighted ICP, Traumatic brain injury, Clinical Neurology, 03 medical and health sciences, Brain trauma, Original Article - Brain trauma, Internal medicine, medicine, MANAGEMENT, Humans, ddc:610, Aged, Retrospective Studies, Brain Injuries, Traumatic/physiopathology, Science & Technology, business.industry, Univariate, 3112 Neurosciences, medicine.disease, 3126 Surgery, anesthesiology, intensive care, radiology, Compensatory reserve, nervous system diseases, Surgery, Neurology (clinical), Neurosciences & Neurology, business, 030217 neurology & neurosurgery
Abstract

Background Compensatory-reserve-weighted intracranial pressure (wICP) has recently been suggested as a supplementary measure of intracranial pressure (ICP) in adult traumatic brain injury (TBI), with a single-center study suggesting an association with mortality at 6 months. No multi-center studies exist to validate this relationship. The goal was to compare wICP to ICP for association with outcome in a multi-center TBI cohort. Methods Using the Collaborative European Neuro Trauma Effectiveness Research in TBI (CENTER-TBI) high-resolution intensive care unit (ICU) cohort, we derived ICP and wICP (calculated as wICP = (1 − RAP) × ICP; where RAP is the compensatory reserve index derived from the moving correlation between pulse amplitude of ICP and ICP). Various univariate logistic regression models were created comparing ICP and wICP to dichotomized outcome at 6 to 12 months, based on Glasgow Outcome Score—Extended (GOSE) (alive/dead—GOSE ≥ 2/GOSE = 1; favorable/unfavorable—GOSE 5 to 8/GOSE 1 to 4, respectively). Models were compared using area under the receiver operating curves (AUC) and p values. Results wICP displayed higher AUC compared to ICP on univariate regression for alive/dead outcome compared to mean ICP (AUC 0.712, 95% CI 0.615–0.810, p = 0.0002, and AUC 0.642, 95% CI 0.538–746, p

Published
2019

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