Güiza Fabian, Depreitere Bart, Piper Ian, Citerio Giuseppe, Jorens Philippe G, Maas Andrew, Schuhmann Martin U, Lo Tsz-Yan Milly, Donald Rob, Jones Patricia, Maier Gottlieb, Van den Berghe Greet, Meyfroidt Geert
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.
Crit Care Med. 2017 Mar;45(3):e316-e320. doi: 10.1097/CCM.0000000000002080.
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.
Prognostic modeling. Noninterventional, observational, retrospective study.
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).
None.
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.
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.
先前基于多中心Brain-IT数据库的回顾性成年患者数据，开发并验证了一种用于早期检测创伤性脑损伤患者颅内压升高发作的模型。本研究的目的是在近期接受治疗的成年和儿科创伤性脑损伤患者的不同队列中验证该早期检测模型。
预后建模。非干预性、观察性、回顾性研究。
成年验证队列包括来自蒙扎圣杰拉尔多医院（n = 50）、鲁汶大学医院（n = 26）、安特卫普大学医院（n = 19）、图宾根大学医院（n = 18）和格拉斯哥南部总医院（n = 8）的近期创伤性脑损伤患者。儿科验证队列包括来自爱丁堡和纽卡斯尔神经外科和重症监护中心的患者（n = 79）。
无。
从区分度、校准、总体表现和临床实用性方面评估了该模型的性能。在近期成年验证队列中，该模型保持了与原研究中一样的优异性能。在儿科验证队列中，该模型保持了良好的区分度和正净效益，尽管在其余标准方面性能有所下降。
所获得的外部验证结果证实了该模型在预测成年和儿科创伤性脑损伤患者未来30分钟内颅内压升高事件方面的稳健性。这些结果朝着一个可普遍应用的颅内压升高预警系统迈出了一大步。此外，该模型仅使用两个常规监测信号（颅内压和平均动脉血压）作为输入，其简洁性是另一优势。
