Evidence map›Paper›PMID 31340932›Full record

SynthesisBMJ (Clinical research ed.)2019

Diagnosis of elevated intracranial pressure in critically ill adults: systematic review and meta-analysis.

Shannon M Fernando, Alexandre Tran, Wei Cheng, Bram Rochwerg, Monica Taljaard, Kwadwo Kyeremanteng, Shane W English, Mypinder S Sekhon, Donald E G Griesdale, Dar Dowlatshahi and 6 more

Registry-linked trialAbstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in BMJ (Clinical research ed.), 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT05593380 (The Impact of Invasive Intracranial Pressure Monitoring Guided Management on the Functional Outcomes of Patients With Supratentorial Large Volume Cerebral Hemorrhage), which is not on this map. Cited by 90 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
90citing papers in PubMed, 2 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT05593380 nacompletednot on this mapstarted 2022, after this paper: background citation

The Impact of Invasive Intracranial Pressure Monitoring Guided Management on the Functional Outcomes of Patients With Supratentorial Large Volume Cerebral Hemorrhage: An Open Label, Randomized, Controlled, Multi-center Trial (BIATICH)

TypeinterventionalSponsorXiangya Hospital of Central South UniversityRan2022 to 2025Enrolled193ConditionsCerebral Hemorrhage, Hypertensive, Intracranial Hypertension, Monitoring, Critical CareArmsParenchymal Intracranial pressure monitor, Treatment based on clinical and imaging observations
3 · Its place in the literature

Who cites it

90 citing papers in PubMed, 2 syntheses or guidelines pooled it.

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30 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

16 authors.

Shannon M FernandoDivision of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada sfernando@qmed.ca.ORCID 0000-0003-4549-4289
Alexandre TranSchool of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.
Wei ChengClinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
Bram RochwergDepartment of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada.
Monica TaljaardSchool of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.
Kwadwo KyeremantengDivision of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
Shane W EnglishDivision of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
Mypinder S SekhonDepartment of Medicine, Division of Critical Care Medicine, University of British Columbia, Vancouver, BC, Canada.
Donald E G GriesdaleDepartment of Medicine, Division of Critical Care Medicine, University of British Columbia, Vancouver, BC, Canada.
Dar DowlatshahiSchool of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.
Victoria A McCredieInterdepartmental Division of Critical Care, Department of Medicine, University of Toronto, Toronto, ON, Canada.
Eelco F M WijdicksDivision of Neurocritical Care and Hospital Neurology, Department of Neurology, Mayo Clinic, Rochester, MN, USA.
Saleh A AlmenawerDivision of Neurosurgery, Department of Surgery, McMaster University, Hamilton, ON, Canada.
Kenji InabaDivision of Acute Care Surgery, Department of Surgery, University of Southern California, Los Angeles, CA, USA.
Venkatakrishna RajajeeDepartment of Neurology, University of Michigan, Ann Arbor, MI, USA.
Jeffrey J PerryDepartment of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectivesTo summarise and compare the accuracy of physical examination, computed tomography (CT), sonography of the optic nerve sheath diameter (ONSD), and transcranial Doppler pulsatility index (TCD-PI) for the diagnosis of elevated intracranial pressure (ICP) in critically ill patients.

designSystematic review and meta-analysis. DATA SOURCES: Six databases, including Medline, EMBASE, and PubMed, from inception to 1 September 2018. STUDY SELECTION CRITERIA: English language studies investigating accuracy of physical examination, imaging, or non-invasive tests among critically ill patients. The reference standard was ICP of 20 mm Hg or more using invasive ICP monitoring, or intraoperative diagnosis of raised ICP. DATA EXTRACTION: Two reviewers independently extracted data and assessed study quality using the quality assessment of diagnostic accuracy studies tool. Summary estimates were generated using a hierarchical summary receiver operating characteristic (ROC) model.

results40 studies (n=5123) were included. Of physical examination signs, pooled sensitivity and specificity for increased ICP were 28.2% (95% confidence interval 16.0% to 44.8%) and 85.9% (74.9% to 92.5%) for pupillary dilation, respectively; 54.3% (36.6% to 71.0%) and 63.6% (46.5% to 77.8%) for posturing; and 75.8% (62.4% to 85.5%) and 39.9% (26.9% to 54.5%) for Glasgow coma scale of 8 or less. Among CT findings, sensitivity and specificity were 85.9% (58.0% to 96.4%) and 61.0% (29.1% to 85.6%) for compression of basal cisterns, respectively; 80.9% (64.3% to 90.9%) and 42.7% (24.0% to 63.7%) for any midline shift; and 20.7% (13.0% to 31.3%) and 89.2% (77.5% to 95.2%) for midline shift of at least 10 mm. The pooled area under the ROC (AUROC) curve for ONSD sonography was 0.94 (0.91 to 0.96). Patient level data from studies using TCD-PI showed poor performance for detecting raised ICP (AUROC for individual studies ranging from 0.55 to 0.72).

conclusionsAbsence of any one physical examination feature is not sufficient to rule out elevated ICP. Substantial midline shift could suggest elevated ICP, but the absence of shift cannot rule it out. ONSD sonography might have use, but further studies are needed. Suspicion of elevated ICP could necessitate treatment and transfer, regardless of individual non-invasive tests. REGISTRATION: PROSPERO CRD42018105642.

Indexed as

Critical IllnessHumansIntracranial HypertensionPhysical ExaminationReproducibility of ResultsTomography, X-Ray ComputedUltrasonography, Doppler, Transcranial

Identifiers

PMID31340932
PMCPMC6651068

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.