Observational studyActa neurochirurgica2024
Critical ICP thresholds in relation to outcome: Is 22 mmHg really the answer?
Observational study in Acta neurochirurgica, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.
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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.
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Who cites it
10 citing papers in PubMed.
- Artificial Intelligence for Early Prediction of Intracranial Hypertension: From Single-Centre Development to Multicentre Validation.Neurocritical care · 2026Article
- Intracranial pressure physiology, monitoring and individualized management in the acute brain injured patient.Intensive care medicine · 2026Review
- Intracranial Pressure Estimation Using B4C Device: A Systematic Review on the Validation Studies.Neurocritical care · 2026Review
- Infratentorial Pressure Monitoring in Cerebellar Stroke: Feasibility and Prognostic Utility.Neurocritical care · 2026Article
- Intracranial pressure, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, C-reactive protein, and D-dimer mortality predictors in isolated severe traumatic brain injury.Surgical neurology international · 2026Article
- Exploring Cerebrospinal Compensatory Zones Using a Noninvasive Approach.Neurocritical care · 2025Observational
- Ultra-Sensitive Wireless Capacitive Nanocomposite-Based Pressure Sensors for Health Monitoring.Advanced materials technologies · 2025Article
- Machine learning approach for noninvasive intracranial pressure estimation using pulsatile cranial expansion waveforms.NPJ digital medicine · 2025Article
- Managing Intracranial Pressure Crisis.Current neurology and neuroscience reports · 2024Review
- A Comprehensive Perspective on Intracranial Pressure Monitoring and Individualized Management in Neurocritical Care: Results of a Survey with Global Experts.Neurocritical care · 2024Article
Corrections and comments
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Authors and funding
6 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeIntensive care for patients with traumatic brain injury (TBI) aims, among other tasks, at avoiding high intracranial pressure (ICP), which is perceived to worsen motor and cognitive deficits and increase mortality. International recommendations for threshold values for ICP were increased from 20 to 22 mmHg in 2016 following the findings in a study by Sorrentino et al., which were based on an observational study of patients with TBI of averaged ICP values. We aimed to reproduce their approach and validate the findings in a separate cohort.
methodsThree hundred thirty-one patients with TBI were included and categorised according to survival/death and favourable/unfavourable outcome at 6 months (based on Glasgow Outcome Score-Extended of 6-8 and 1-5, respectively). Repeated chi-square tests of survival and death (or favourable and unfavourable outcome) vs. high and low ICP were conducted with discrimination between high and low ICP sets at increasing values (integers) between 10 and 35 mmHg, using the average ICP for the entire monitoring period. The ICP limit returning the highest chi-square score was assumed to be the threshold with best discriminative ability. This approach was repeated after stratification by sex, age, and initial Glasgow Coma Score (GCS).
resultsAn ICP limit of 18 mmHg was found for both mortality and unfavourable outcome for the entire cohort. The female and the low GCS subgroups both had threshold values of 18 mmHg; for all other subgroups, the threshold varied between 16 and 30 mmHg. According to a multiple logistic regression analysis, age, initial GCS, and average ICP are independently associated with mortality and outcome.
conclusionsUsing identical methods and closely comparable cohorts, the critical thresholds for ICP found in the study by Sorrentino et al. could not be reproduced.
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