Evidence map›Paper›PMID 40016530›Full record

Observational studyActa neurochirurgica2025

Autoregulatory-guided management in traumatic brain injury: does age matter?

Teodor Svedung Wettervik, Erta Beqiri, Anders Hånell, Stefan Yu Bögli, Ihsane Olakorede, Xuhang Chen, Adel Helmy, Andrea Lavinio, Peter J Hutchinson, Peter Smielewski

Abstract readObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in Acta neurochirurgica, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
–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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed.

  1. Article
  2. Article
  3. Review
  4. Article
  5. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Teodor Svedung WettervikDepartment of Medical Sciences, Section of Neurosurgery, Uppsala University, 751 85, Uppsala, Sweden. teodor.svedung-wettervik@neuro.uu.se.
Erta BeqiriBrain Physics Laboratory, Department of Clinical Neurosciences, Division of Neurosurgery, University of Cambridge, Cambridge, UK.
Anders HånellDepartment of Medical Sciences, Section of Neurosurgery, Uppsala University, 751 85, Uppsala, Sweden.
Stefan Yu BögliBrain Physics Laboratory, Department of Clinical Neurosciences, Division of Neurosurgery, University of Cambridge, Cambridge, UK.
Ihsane OlakoredeBrain Physics Laboratory, Department of Clinical Neurosciences, Division of Neurosurgery, University of Cambridge, Cambridge, UK.
Xuhang ChenBrain Physics Laboratory, Department of Clinical Neurosciences, Division of Neurosurgery, University of Cambridge, Cambridge, UK.
Adel HelmyDepartment of Clinical Neurosciences, Division of Neurosurgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK.
Andrea LavinioNeurosciences and Trauma Critical Care Unit, Addenbrooke's Hospital, Cambridge University Hospitals, Cambridge, UK.
Peter J HutchinsonDepartment of Clinical Neurosciences, Division of Neurosurgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK.
Peter SmielewskiBrain Physics Laboratory, Department of Clinical Neurosciences, Division of Neurosurgery, University of Cambridge, Cambridge, UK.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundAlthough older traumatic brain injury (TBI) patients often exhibit cerebral autoregulatory impairment with high pressure reactivity index (PRx), the role of autoregulatory-guided management in these patients remains elusive. In this study, we aimed to explore if age affected the prognostic role of the autoregulatory variables, PRx and the PRx-derived optimal cerebral perfusion pressure (CPPopt), in a large TBI cohort.

methodsIn this observational study, 550 TBI patients who had been treated in the neurocritical care unit, Addenbrooke's Hospital, Cambridge, UK, between 2002 and 2022 with available data on age, intracranial pressure monitoring, and outcome (Glasgow Outcome Scale [GOS]) were included. The patients were classified into three age groups; youth and early adulthood (16-39 years), middle adulthood (40-59 years), and senior adulthood (60 years and above). Autoregulatory variables were studied in relation to outcome using heatmaps. Multivariate logistic regressions of mortality and favourable outcome (GOS 4 to 5) were performed with PRx and ΔCPPopt (CPP-CPPopt) in addition to baseline variables.

resultsTBI patients in the senior adulthood group exhibited higher PRx and lower ICP than younger patients. There was a transition towards worse outcome with higher PRx in heatmaps for all age groups. The combination of high PRx together with low CPP or negative ΔCPPopt was particularly associated with lower GOS. In multivariate logistic regressions, higher PRx remained independently associated with higher mortality and lower rate of favourable outcome in the senior adulthood cohort. There was a transition towards worse outcome for negative ΔCPPopt for all age groups, but it did not reach statistical significance for the senior adulthood group.

conclusionsPRx was found to be an independent outcome predictor and influenced the safe and dangerous CPP and ΔCPPopt interval for all age groups. Thus, TBI patients older than 60 years may also benefit from autoregulatory-guided management and should not necessarily be excluded from future trials on such therapeutic strategies.

Indexed as

Brain Injuries, TraumaticCerebrovascular CirculationHomeostasisIntracranial PressureAdolescentAdultAgedAge FactorsFemaleGlasgow Outcome ScaleHumansMaleMiddle AgedPrognosisYoung AdultAgeNeurocritical careOptimal cerebral perfusion pressurePressure reactivity indexTraumatic brain injury

Identifiers

PMID40016530
PMCPMC11868309

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Registered trials

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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.