title: Quantification of secondary CPP insult severity in paediatric head injured patients using a pressure-time index.
abstract: This paper describes and validates a new Cumulative Pressure-Time Index (CPT) which takes into account both duration and degree of cerebral perfusion pressure (CPP) derangement and determines critical thresholds for CPP, in a paediatric head injury dataset. Sixty-six head-injured children, with invasive minute-to-minute intracranial pressure (ICP) and blood pressure monitoring, had their pre-set CPP derangement episodes (outside the normal range) identified in three childhood age-bands (2-6, 7-10, and 11-16 years) and global outcome assessed at six months post injury. The new cumulative pressure-time index more accurately predicted outcome than previously used summary measures and by varying the threshold CPP values, it was found that these physiological threshold values (< or = 48, < or = 52 and < or = 56 mmHg for 2-6, 7-10, and 11-16 years respectively) best predicted brain insult in terms of subsequent mortality and morbidity.
authors.affiliation: Child Life and Health, University of Edinburgh, Edinburgh, UK.
authors.forename: P A
authors.initials: PA
authors.lastname: Jones
authors.forename: I R
authors.initials: IR
authors.lastname: Chambers
authors.forename: T Y M
authors.initials: TY
authors.lastname: Lo
authors.forename: P J D
authors.initials: PJ
authors.lastname: Andrews
authors.forename: W
authors.initials: W
authors.lastname: Chaudhry
authors.forename: A
authors.initials: A
authors.lastname: Clark
authors.forename: J
authors.initials: J
authors.lastname: Croft
authors.forename: R
authors.initials: R
authors.lastname: Forsyth
authors.forename: B
authors.initials: B
authors.lastname: Fulton
authors.forename: A D
authors.initials: AD
authors.lastname: Mendelow
authors.forename: G
authors.initials: G
authors.lastname: Wilson
authors.forename: R A
authors.initials: RA
authors.lastname: Minns
mesh_terms: D000293:Adolescent; D001794:Blood Pressure; D002648:Child; D002675:Child, Preschool; D006259:Craniocerebral Trauma / Q000150:complications*; D005260:Female; D006801:Humans; D019586:Intracranial Hypertension / Q000145:classification* / Q000209:etiology / Q000401:mortality; D007427:Intracranial Pressure; D008297:Male; D008365:Manometry / Q000379:methods* / Q000592:standards; D011379:Prognosis; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012680:Sensitivity and Specificity; D015599:Trauma Severity Indices; D006113:United Kingdom / Q000453:epidemiology