Abstract：
BACKGROUND: The study investigated the effectiveness of low-frequency sampling in detecting alterations in cerebrovascular reactivity (CVR) associated with changes in intracranial pressure (ICP) in patients with traumatic brain injury (TBI) across different age groups. The primary objective was to investigate an ICP threshold that indicates a decrease in CVR as evidenced by a significant increase in the ultra-low-frequency pressure reactivity index (UL-PRx). Additionally, the study aimed to develop an age-based categorization method for patients with TBI to investigate the differences between these ICP thresholds in different age groups.
METHODS: In this retrospective analysis, data from 263 patients with TBI were prospectively collected. ICP and mean arterial pressure were extracted from the hospital database at 5-min intervals. Demographic details, clinical presentation, computed tomography scans, neurosurgical interventions, and 12-months outcome were recorded. ICP versus UL-PRx values were categorized into ICP bins and graphically represented with boxplots for each age group, illustrating how as ICP values rise, there is a bin (age-tailored ICP [AT-ICP]) beyond which UL-PRx shows a sudden increase, indicating CVR loss. Homogeneous age groups were established to obtain a consistent AT-ICP threshold. The discriminatory ability of the AT-ICP thresholds was compared with the guideline-recommended thresholds by calculating the area under the Receiver Operating Characteristic curve of the ICP-derived indices (dose above threshold, and the hourly dosage above threshold).
RESULTS: Age groups 0-5, 6-20, 21-60, 61-70, and 71-85 years were the best age subdivisions, corresponding to AT-ICP thresholds of 20, 30, 35, 25, and 30 mmHg, respectively. The AT-ICP thresholds exhibited better discriminative ability compared with the guideline-recommended thresholds.
CONCLUSIONS: The AT-ICP thresholds offer a novel approach for estimating CVR impairment and the developed method represents an alternative solution to address the age stratification issue in patients with TBI.
METHODS: In this retrospective analysis, data from 263 patients with TBI were prospectively collected. ICP and mean arterial pressure were extracted from the hospital database at 5-min intervals. Demographic details, clinical presentation, computed tomography scans, neurosurgical interventions, and 12-months outcome were recorded. ICP versus UL-PRx values were categorized into ICP bins and graphically represented with boxplots for each age group, illustrating how as ICP values rise, there is a bin (age-tailored ICP [AT-ICP]) beyond which UL-PRx shows a sudden increase, indicating CVR loss. Homogeneous age groups were established to obtain a consistent AT-ICP threshold. The discriminatory ability of the AT-ICP thresholds was compared with the guideline-recommended thresholds by calculating the area under the Receiver Operating Characteristic curve of the ICP-derived indices (dose above threshold, and the hourly dosage above threshold).
RESULTS: Age groups 0-5, 6-20, 21-60, 61-70, and 71-85 years were the best age subdivisions, corresponding to AT-ICP thresholds of 20, 30, 35, 25, and 30 mmHg, respectively. The AT-ICP thresholds exhibited better discriminative ability compared with the guideline-recommended thresholds.
CONCLUSIONS: The AT-ICP thresholds offer a novel approach for estimating CVR impairment and the developed method represents an alternative solution to address the age stratification issue in patients with TBI.
摘要：
背景：该研究调查了低频采样在检测不同年龄段创伤性脑损伤（TBI）患者中与颅内压（ICP）变化相关的脑血管反应性（CVR）变化中的有效性。主要目的是研究表明CVR降低的ICP阈值，这可以通过超低频率压力反应性指数（UL-PRx）的显着增加来证明。此外,该研究旨在为TBI患者开发一种基于年龄的分类方法,以调查不同年龄组ICP阈值之间的差异.
方法：在本回顾性分析中，前瞻性收集了263例TBI患者的数据.每隔5分钟从医院数据库中提取ICP和平均动脉压。人口统计细节，临床表现,计算机断层扫描,神经外科干预，并记录12个月的结局.将ICP与UL-PRx值分类到ICP箱中，并用箱线图以图形方式表示每个年龄组。说明了随着ICP值的上升，有一个bin（按年龄定制的ICP[AT-ICP]），UL-PRx显示出突然增加，指示CVR损失。建立同年龄组以获得一致的AT-ICP阈值。通过计算ICP衍生指标的接收器工作特征曲线下的面积，将AT-ICP阈值的判别能力与指南推荐的阈值进行比较（高于阈值的剂量，和高于阈值的每小时剂量)。
结果：0-5、6-20、21-60、61-70和71-85岁年龄组是最佳年龄细分，对应于20、30、35、25和30mmHg的AT-ICP阈值，分别。与指南推荐的阈值相比，AT-ICP阈值表现出更好的辨别能力。
结论：AT-ICP阈值提供了一种评估CVR损害的新方法，所开发的方法代表了解决TBI患者年龄分层问题的替代解决方案。
方法：在本回顾性分析中，前瞻性收集了263例TBI患者的数据.每隔5分钟从医院数据库中提取ICP和平均动脉压。人口统计细节，临床表现,计算机断层扫描,神经外科干预，并记录12个月的结局.将ICP与UL-PRx值分类到ICP箱中，并用箱线图以图形方式表示每个年龄组。说明了随着ICP值的上升，有一个bin（按年龄定制的ICP[AT-ICP]），UL-PRx显示出突然增加，指示CVR损失。建立同年龄组以获得一致的AT-ICP阈值。通过计算ICP衍生指标的接收器工作特征曲线下的面积，将AT-ICP阈值的判别能力与指南推荐的阈值进行比较（高于阈值的剂量，和高于阈值的每小时剂量)。
结果：0-5、6-20、21-60、61-70和71-85岁年龄组是最佳年龄细分，对应于20、30、35、25和30mmHg的AT-ICP阈值，分别。与指南推荐的阈值相比，AT-ICP阈值表现出更好的辨别能力。
结论：AT-ICP阈值提供了一种评估CVR损害的新方法，所开发的方法代表了解决TBI患者年龄分层问题的替代解决方案。
