Evidence map›Paper›PMID 42106863›Full record

ArticleCritical care (London, England)2026

Intracranial compliance monitoring using pulse shape index in traumatic brain injury: relation to cerebral physiology and clinical outcome.

Teodor Svedung Wettervik, Erta Beqiri, Anders Hånell, Agnieszka Kazimierska, Magdalena Kasprowicz, Peter Smielewski

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Article in Critical care (London, England), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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4 · The record

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5 · Who and what money

Authors and funding

6 authors.

Teodor Svedung WettervikDepartment of Medical Sciences, Section of Neurosurgery, Uppsala University, Uppsala, SE-751 85, 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, Uppsala, SE-751 85, Sweden.
Agnieszka KazimierskaDepartment of Biomedical Engineering, Faculty of Fundamental Problems of Technology, Wroclaw University of Science and Technology, Wroclaw, Poland.
Magdalena KasprowiczDepartment of Biomedical Engineering, Faculty of Fundamental Problems of Technology, Wroclaw University of Science and Technology, Wroclaw, Poland.
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

backgroundThe intracranial pressure (ICP) pulse waveform reflects intracranial compliance. The pulse shape index (PSI), an artificial intelligence (AI)-based metric ranging from 1 (normal) to 4 (disturbed), quantifies morphological waveform pathologies. Early findings in smaller cohorts indicate that elevated PSI is associated with mass lesions, aging, higher ICP, and worse outcome. This study examined how PSI relates to other markers of intracranial compliance, the risk of ICP crisis, and clinical outcome in a large traumatic brain injury (TBI) cohort.

methodsThis retrospective study included 321 TBI patients with ≥ 12 h of ICP/PSI monitoring. PSI was analysed in relation to ICP, ICP pulse amplitude (AmpICP), the moving correlation coefficient between mean ICP and ICP amplitude (RAP index), and arterial blood pressure (ABP) using generalised additive models (GAMs). Linear mixed-effects models assessed whether PSI during preceding hours predicted later ICP elevations (e.g., ICP > 20/22 mmHg). The prognostic value of PSI was tested using univariable Mann-Whitney U test and multivariable (after adjustment for age, Glasgow Coma Scale, ICP, CPP, and PRx) logistic regression for mortality (Glasgow Outcome Scale = 1) and favourable outcome (Glasgow Outcome Scale = 4-5).

resultsPSI increased with higher ICP, AmpICP, RAP, and ABP. PSI during the preceding hour predicted increased ICP burden above 20 mmHg (marginal R

conclusionsPSI was linked to established indicators of intracranial compliance and provided early warning of impending intracranial hypertension. While PSI showed univariable associations with outcome, these did not remain in multivariable models. Retrospectively, PSI does not appear to have independent prognostic value, but rather a complementary value. Prospectively, it may serve as a dynamic marker of deteriorating intracranial compliance and an early signal for future ICP crisis.

Indexed as

Brain Injuries, TraumaticIntracranial PressureAdultFemaleGlasgow Coma ScaleHumansMaleMiddle AgedMonitoring, PhysiologicRetrospective StudiesIntracranial complianceIntracranial pressureNeurocritical carePulse shape indexTraumatic brain injury

Identifiers

PMID42106863
PMCPMC13159340

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