Quantification of secondary CPP insult severity in paediatric head injured patients using a pressure-time index.
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.
Jones
P A
PA
Child Life and Health, University of Edinburgh, Edinburgh, UK.
Chambers
I R
IR
Lo
T Y M
TY
Andrews
P J D
PJ
Chaudhry
W
W
Clark
A
A
Croft
J
J
Forsyth
R
R
Fulton
B
B
Mendelow
A D
AD
Wilson
G
G
Minns
R A
RA
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