Clinical Decision Support for Traumatic Brain Injury: Identifying a Framework for Practical Model-Based Intracranial Pressure Estimation at Multihour Timescales.
Clinical Decision Support for Traumatic Brain Injury: Identifying a Framework for Practical Model-Based Intracranial Pressure Estimation at Multihour Timescales.
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DOI：
10.2196/23215
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发表时间：
2021-03-22
影响因子：
3.2
通讯作者：
Albers D
中科院分区：
文献类型：
--
作者：
Stroh JN;Bennett TD;Kheyfets V;Albers D
临床上减轻创伤性脑损伤引起的颅内高压需要及时了解颅内压，以避免继发性损伤或死亡。无创颅内压（nICP）估计，操作足够快，在多小时的时间尺度，只需要常见的患者测量是一个理想的工具，临床决策支持和改善创伤性脑损伤患者的结果。然而，现有的基于模型的nICP估计方法可能太慢或需要不易获得的数据。这项工作考虑了基于动脉血压（ABP）的多小时时间尺度的短期和实时nICP估计，以更好地为正在进行的具有常用数据的实用模型的开发提供信息。我们评估和分析模型开发的两种不同途径的影响，通过使用简单的压力估计模型增加生理整合，或通过使用更复杂的模型增加生理保真度。使用一组定量模型验证标准在小时尺度时间内进行模型方法的比较，应用于模型nICP估计与观察到的ICP。当提供脉动ABP流入条件时，基于窗口回归的简单全耦合估计方案优于具有规定颅内流入的更复杂nICP模型。我们还表明，简单的估计数据的要求，可以减少到1分钟的平均ABP汇总数据下的通用波形表示。简单双向模型的更强性能表明，全身血管网络和nICP估计方案之间的反馈对于长时间间隔的建模至关重要。然而，简单的模型简化为仅依赖于ABP限制了其在涉及其他脑损伤（如缺血性卒中和蛛网膜下腔出血）的病例中的实用性。说明和讨论了克服这些限制所需的其他方法和考虑因素。
The clinical mitigation of intracranial hypertension due to traumatic brain injury requires timely knowledge of intracranial pressure to avoid secondary injury or death. Noninvasive intracranial pressure (nICP) estimation that operates sufficiently fast at multihour timescales and requires only common patient measurements is a desirable tool for clinical decision support and improving traumatic brain injury patient outcomes. However, existing model-based nICP estimation methods may be too slow or require data that are not easily obtained. This work considers short- and real-time nICP estimation at multihour timescales based on arterial blood pressure (ABP) to better inform the ongoing development of practical models with commonly available data. We assess and analyze the effects of two distinct pathways of model development, either by increasing physiological integration using a simple pressure estimation model, or by increasing physiological fidelity using a more complex model. Comparison of the model approaches is performed using a set of quantitative model validation criteria over hour-scale times applied to model nICP estimates in relation to observed ICP. The simple fully coupled estimation scheme based on windowed regression outperforms a more complex nICP model with prescribed intracranial inflow when pulsatile ABP inflow conditions are provided. We also show that the simple estimation data requirements can be reduced to 1-minute averaged ABP summary data under generic waveform representation. Stronger performance of the simple bidirectional model indicates that feedback between the systemic vascular network and nICP estimation scheme is crucial for modeling over long intervals. However, simple model reduction to ABP-only dependence limits its utility in cases involving other brain injuries such as ischemic stroke and subarachnoid hemorrhage. Additional methodologies and considerations needed to overcome these limitations are illustrated and discussed.
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DOI：
10.1093/jamia/ocy106
发表时间：
2018-10-01
期刊：
Journal of the American Medical Informatics Association : JAMIA
影响因子：
--
作者：
Albers DJ;Levine ME;Stuart A;Mamykina L;Gluckman B;Hripcsak G
通讯作者：
Hripcsak G
影响因子：
--
作者：
Khan, Marium Naveed;Shallwani, Hussain;Shamim, Muhammad Shahzad
通讯作者：
Shamim, Muhammad Shahzad
影响因子：
11
作者：
Czosnyka, M;Piechnik, S;Pickard, JD
通讯作者：
Pickard, JD
影响因子：
3
作者：
Farhadi, Akram;Chern, Joshua J.;Rasheed, Khaled
通讯作者：
Rasheed, Khaled
影响因子：
4.2
作者：
Cardim, Danilo;Robba, Chiara;Czosnyka, Marek
通讯作者：
Czosnyka, Marek