ArticleEmergency medicine journal : EMJ2021
Prehospital clinical signs are a poor predictor of raised intracranial pressure following traumatic brain injury.
Article in Emergency medicine journal : EMJ, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers.
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15 citing papers in PubMed, 34 citations in OpenAlex.
- Non-invasive intracranial pressure estimation in the intensive care unit: narrative review of methods and clinical applications.Intensive care medicine · 2026Review
- Bedside transcranial Doppler as a diagnostic bridge for suspected intracranial hypertension after traumatic brain injury surgery: A case report.Surgical neurology international · 2026Article
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- Brain Injury Associated Shock: An Under-Recognized and Challenging Prehospital Phenomenon.Prehospital and disaster medicine · 2024Observational
- The Australian Traumatic Brain Injury Initiative: Systematic Review of Clinical Factors Associated with Outcomes in People with Moderate-Severe Traumatic Brain Injury.Neurotrauma reports · 2024Review
- Correlation of Point of Care Ultrasound (POCUS) Guided Pupillary Assessment Parameter with Glasgow Coma Scale in Patients with Altered Mental Status- A Cross Sectional Study.POCUS journal · 2024Article
- Initial Diagnosis and Management of Acutely Elevated Intracranial Pressure.Journal of intensive care medicine · 2023Review
- Machine learning-based prediction of emergency neurosurgery within 24 h after moderate to severe traumatic brain injury.World journal of emergency surgery : WJES · 2022Article
- Relationship between admission vitals and brain herniation in 32 cats: a retrospective study.Journal of feline medicine and surgery · 2022Article
- A Prehospital Triage System to Detect Traumatic Intracranial Hemorrhage Using Machine Learning Algorithms.JAMA network open · 2022Article
- Standardised data collection in prehospital critical care: a comparison of medical problem categories and discharge diagnoses.Scandinavian journal of trauma, resuscitation and emergency medicine · 2022Observational
- Article
- Accuracy of Optic Nerve Sheath Diameter Measurements in Pocket-Sized Ultrasound Devices in a Simulation Model.Frontiers in medicine · 2022Article
- Anaesthetic management in a cat undergoing emergency craniotomy for meningioma excision.JFMS open reportsArticle
- Silent threat: The deadly face of acute respiratory symptoms in earthquake survivors.Turkish journal of emergency medicineArticle
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Authors and funding
4 authors at 3 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundFor the prehospital diagnosis of raised intracranial pressure (ICP), clinicians are reliant on clinical signs such as the Glasgow Coma Score (GCS), pupillary response and/or Cushing's triad (hypertension, bradycardia and an irregular breathing pattern). This study aimed to explore the diagnostic accuracy of these signs as indicators of a raised ICP.
methodsWe performed a retrospective cohort study of adult patients attended by a Helicopter Emergency Medical Service (Air Ambulance Kent, Surrey Sussex), who had sustained a traumatic brain injury (TBI), requiring prehospital anaesthesia between 1 January 2016 and 1 January 2018. We established optimal cut-off values for clinical signs to identify patients with a raised ICP and investigated diagnostic accuracy for combinations of these values.
resultsOutcome data for 249 patients with TBI were available, of which 87 (35%) had a raised ICP. Optimal cut-off points for systolic blood pressure (SBP), heart rate (HR) and pupil diameter to discriminate patients with a raised ICP were, respectively, >160 mm Hg,<60 bpm and >5 mm. Cushing criteria (SBP >160 mm Hg and HR <60 bpm) and pupillary response and size were complimentary in their ability to detect patients with a raised ICP. The presence of a fixed blown pupil or a Cushing's response had a specificity of 93.2 (88.2-96.6)%, and a positive likelihood ratio (LR+) of 5.4 (2.9-10.2), whereas sensitivity and LR- were only 36.8 (26.7-47.8)% and 0.7 (0.6-0.8), respectively, (Area Under the Curve (AUC) 0.65 (0.57-0.73)). Sensitivity analysis revealed that optimal cut-off values and resultant accuracy were dependent on injury pattern.
conclusionTraditional clinical signs of raised ICP may under triage patients to prehospital treatment with hyperosmolar drugs. Further research should identify more accurate clinical signs or alternative non-invasive diagnostic aids in the prehospital environment.
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