title: Early Detection of Increased Intracranial Pressure Episodes in Traumatic Brain Injury: External Validation in an Adult and in a Pediatric Cohort.
abstract: OBJECTIVE
  A model for early detection of episodes of increased intracranial pressure in traumatic brain injury patients has been previously developed and validated based on retrospective adult patient data from the multicenter Brain-IT database. The purpose of the present study is to validate this early detection model in different cohorts of recently treated adult and pediatric traumatic brain injury patients.
  
  
  METHODS
  Prognostic modeling. Noninterventional, observational, retrospective study.
  
  
  METHODS
  The adult validation cohort comprised recent traumatic brain injury patients from San Gerardo Hospital in Monza (n = 50), Leuven University Hospital (n = 26), Antwerp University Hospital (n = 19), Tübingen University Hospital (n = 18), and Southern General Hospital in Glasgow (n = 8). The pediatric validation cohort comprised patients from neurosurgical and intensive care centers in Edinburgh and Newcastle (n = 79).
  
  
  METHODS
  None.
  
  
  RESULTS
  The model's performance was evaluated with respect to discrimination, calibration, overall performance, and clinical usefulness. In the recent adult validation cohort, the model retained excellent performance as in the original study. In the pediatric validation cohort, the model retained good discrimination and a positive net benefit, albeit with a performance drop in the remaining criteria.
  
  
  CONCLUSIONS
  The obtained external validation results confirm the robustness of the model to predict future increased intracranial pressure events 30 minutes in advance, in adult and pediatric traumatic brain injury patients. These results are a large step toward an early warning system for increased intracranial pressure that can be generally applied. Furthermore, the sparseness of this model that uses only two routinely monitored signals as inputs (intracranial pressure and mean arterial blood pressure) is an additional asset.
authors.affiliation: 1Department of Intensive Care Medicine, University Hospitals Leuven, Leuven, Belgium. 2Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium. 3Department of Clinical Physics, Southern General Hospital, Glasgow, United Kingdom. 4NeuroIntensive Care, Department of Emergency and Intensive Care, San Gerardo Hospital, Monza, Italy. 5Department of Intensive Care Medicine, Antwerp University Hospital, Edegem, Belgium. 6Department of Neurosurgery, Antwerp University Hospital, Edegem, Belgium. 7Department of Neurosurgery, Klinik für Neurochirurgie, Universitätsklinikum Tübingen, Tübingen, Germany. 8Department of Paediatric Intensive Care, Royal Hospital for Sick Children, Edinburgh, United Kingdom. 9School of Mathematics and Statistics, University of Glasgow, Glasgow, United Kingdom. 10Department of Paediatric Neurology, Royal Hospital for Sick Children, Edinburgh, United Kingdom.
authors.forename: Fabian
authors.initials: F
authors.lastname: Güiza
authors.forename: Bart
authors.initials: B
authors.lastname: Depreitere
authors.forename: Ian
authors.initials: I
authors.lastname: Piper
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Citerio
authors.forename: Philippe G
authors.initials: PG
authors.lastname: Jorens
authors.forename: Andrew
authors.initials: A
authors.lastname: Maas
authors.forename: Martin U
authors.initials: MU
authors.lastname: Schuhmann
authors.forename: Tsz-Yan Milly
authors.initials: TM
authors.lastname: Lo
authors.forename: Rob
authors.initials: R
authors.lastname: Donald
authors.forename: Patricia
authors.initials: P
authors.lastname: Jones
authors.forename: Gottlieb
authors.initials: G
authors.lastname: Maier
authors.forename: Greet
authors.initials: G
authors.lastname: Van den Berghe
authors.forename: Geert
authors.initials: G
authors.lastname: Meyfroidt
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000070642:Brain Injuries, Traumatic / Q000150:complications*; D002648:Child; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D019586:Intracranial Hypertension / Q000175:diagnosis* / Q000209:etiology*; D007427:Intracranial Pressure; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D013997:Time Factors; D055815:Young Adult