Diagnosis of elevated intracranial pressure in critically ill adults: systematic review and meta-analysis.
Authors of this article are:
Fernando SM, Tran A, Cheng W, Rochwerg B, Taljaard M, Kyeremanteng K, English SW, Sekhon MS, Griesdale DEG, Dowlatshahi D, McCredie VA, Wijdicks EFM, Almenawer SA, Inaba K, Rajajee V, Perry JJ.
A summary of the article is shown below:
OBJECTIVES: To summarise and compare the accuracy of physical examination, computed tomography (CT), sonography of the optic nerve sheath diameter (ONSD), and transcranial Doppler pulsatility index (TCD-PI) for the diagnosis of elevated intracranial pressure (ICP) in critically ill patients.DESIGN: Systematic review and meta-analysis.DATA SOURCES: Six databases, including Medline, EMBASE, and PubMed, from inception to 1 September 2018.STUDY SELECTION CRITERIA: English language studies investigating accuracy of physical examination, imaging, or non-invasive tests among critically ill patients. The reference standard was ICP of 20 mm Hg or more using invasive ICP monitoring, or intraoperative diagnosis of raised ICP.DATA EXTRACTION: Two reviewers independently extracted data and assessed study quality using the quality assessment of diagnostic accuracy studies tool. Summary estimates were generated using a hierarchical summary receiver operating characteristic (ROC) model.RESULTS: 40 studies (n=5123) were included. Of physical examination signs, pooled sensitivity and specificity for increased ICP were 28.2% (95% confidence interval 16.0% to 44.8%) and 85.9% (74.9% to 92.5%) for pupillary dilation, respectively; 54.3% (36.6% to 71.0%) and 63.6% (46.5% to 77.8%) for posturing; and 75.8% (62.4% to 85.5%) and 39.9% (26.9% to 54.5%) for Glasgow coma scale of 8 or less. Among CT findings, sensitivity and specificity were 85.9% (58.0% to 96.4%) and 61.0% (29.1% to 85.6%) for compression of basal cisterns, respectively; 80.9% (64.3% to 90.9%) and 42.7% (24.0% to 63.7%) for any midline shift; and 20.7% (13.0% to 31.3%) and 89.2% (77.5% to 95.2%) for midline shift of at least 10 mm. The pooled area under the ROC (AUROC) curve for ONSD sonography was 0.94 (0.91 to 0.96). Patient level data from studies using TCD-PI showed poor performance for detecting raised ICP (AUROC for individual studies ranging from 0.55 to 0.72).CONCLUSIONS: Absence of any one physical examination feature is not sufficient to rule out elevated ICP. Substantial midline shift could suggest elevated ICP, but the absence of shift cannot rule it out. ONSD sonography might have use, but further studies are needed. Suspicion of elevated ICP could necessitate treatment and transfer, regardless of individual non-invasive tests.REGISTRATION: PROSPERO CRD42018105642.Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Check out the article’s website on Pubmed for more information:
This article is a good source of information and a good way to become familiar with topics such as: Humans;Intracranial Hypertension;Physical Examination;Reproducibility of Results;Tomography, X-Ray Computed;Ultrasonography, Doppler, Transcranial.
New Chemicals from MOLECULAR DEPOT
-
- Sale!
- Chemicals, Interference, Lipids
Triglyceride Mix for Interference Testing
- Original price was: $495.00.$295.00Current price is: $295.00.
- Add to cart
-
- Sale!
- Chemicals
Microparticle Stabilizer Solution
- Original price was: $595.00.$295.00Current price is: $295.00.
- Add to cart
-
- Sale!
- Buffers & Solutions, Chemicals
Enzyme Acceptor Stabilization Buffer
- Original price was: $495.00.$250.00Current price is: $250.00.
- Add to cart
-
- Sale!
- Buffers & Solutions, Chemicals
Enzyme Donor Stabilization Buffer
- Original price was: $495.00.$250.00Current price is: $250.00.
- Add to cart
-
- Sale!
- Chemicals, Conjugates
Progesterone Biotin Conjugate Solution
- Original price was: $650.00.$350.00Current price is: $350.00.
- Add to cart
-
- Sale!
- Buffers & Solutions, Chemicals
Microparticle Activation Buffer
- Original price was: $595.00.$295.00Current price is: $295.00.
- Add to cart
-
- Sale!
- Buffers & Solutions, Chemicals
Microparticle Washing Buffer
- Original price was: $595.00.$295.00Current price is: $295.00.
- Add to cart
-
- Sale!
- Buffers & Solutions, Chemicals
Microparticle Blocking Buffer
- Original price was: $650.00.$350.00Current price is: $350.00.
- Add to cart
-
- Sale!
- Buffers & Solutions, Chemicals
Microparticle Anti Aggregation Agent
- Original price was: $595.00.$295.00Current price is: $295.00.
- Add to cart
-
- Sale!
- Chemicals
CPRG (Chlorophenol red-β-D-galactopyranoside)
- Original price was: $850.00.$395.00Current price is: $395.00.
- Add to cart
New Proteins from MOLECULAR DEPOT
-
- Sale!
- Conjugates, Proteins
Tacrolimus BSA Conjugate Solution
- Original price was: $695.00.$495.00Current price is: $495.00.
- Add to cart
-
- Sale!
- Enzymes, Proteins
Cholesterol Oxidase from Streptomyces sp.
- Original price was: $595.00.$295.00Current price is: $295.00.
- Add to cart
-
- Sale!
- Proteins
Aprotinin from Bovine Lung (Lyophilized powder)
- Original price was: $450.00.$250.00Current price is: $250.00.
- Add to cart
-
- Sale!
- Enzymes, Proteins
Beta-galactosidase Enzyme Donor
- Original price was: $795.00.$450.00Current price is: $450.00.
- Add to cart
-
- Sale!
- Enzymes, Proteins
Beta-galactosidase Enzyme Acceptor
- Original price was: $795.00.$375.00Current price is: $375.00.
- Add to cart
-
- Sale!
- Proteins, Enzymes
Xanthine Oxidase Grade II (Lyophilized Powder)
- Original price was: $695.00.$395.00Current price is: $395.00.
- Add to cart
-
- Sale!
- Enzymes, Proteins
Ascorbate Oxidase (Lyophilized Powder)
- Original price was: $350.00.$250.00Current price is: $250.00.
- Add to cart
-
- Sale!
- Proteins
Silk Fibroin (Bombyx Mori Silkworm)
- Original price was: $595.00.$295.00Current price is: $295.00.
- Add to cart
-
- Sale!
- Proteins
Fibrinogen from Bovine Plasma Lyophilized
- Original price was: $595.00.$295.00Current price is: $295.00.
- Add to cart
-
- Sale!
- Enzymes, Proteins
Horseradish Peroxidase Biotinylated
- Original price was: $595.00.$295.00Current price is: $295.00.
- Add to cart
New Antibodies from MOLECULAR DEPOT
-
- Sale!
- Antibodies
Antibody to Thyroxine T4 Monoclonal
- Original price was: $995.00.$495.00Current price is: $495.00.
- Add to cart
-
- Antibodies
SAA Antibody Monoclonal Anti-Serum Amyloid A
- $350.00 – $1,550.00
- Select options
-
- Antibodies
Valproic Acid Antibody (Mouse Monoclonal)
- $250.00 – $1,095.00
- Select options
-
- Antibodies
Phenytoin Antibody (Mouse Monoclonal)
- $350.00 – $1,450.00
- Select options
-
- Sale!
- Antibodies
Anti Sheep IgG (H+L) Rabbit Polyclonal
- $250.00 – $1,495.00
- Select options
-
- Sale!
- Antibodies
Anti Human IgM Antibody Polyclonal
- Original price was: $595.00.$295.00Current price is: $295.00.
- Add to cart
-
- Sale!
- Antibodies
Myoglobin Antibody (Human Affinity Purified)
- Original price was: $650.00.$350.00Current price is: $350.00.
- Add to cart
-
- Sale!
- Antibodies, Interference
Rheumatoid Factor Interference Blocker
- Original price was: $595.00.$395.00Current price is: $395.00.
- Add to cart
-
- Sale!
- Antibodies, Interference
HAMA Blocking Reagent (Affinity Purified)
- Original price was: $895.00.$450.00Current price is: $450.00.
- Add to cart
New Research Kits from MOLECULAR DEPOT
-
- Sale!
- Interference, Research Kits
Interference Test Kit
- Original price was: $595.00.$395.00Current price is: $395.00.
- Add to cart
-
- Sale!
- Research Kits
Alpha Complementation Kit Beta-galactosidase
- Original price was: $1,395.00.$695.00Current price is: $695.00.
- Add to cart
-
- Sale!
- Research Kits
Crystallization Screen for Protein-DNA Complexes
- Original price was: $1,295.00.$650.00Current price is: $650.00.
- Add to cart
-
- Sale!
- Molecular Biology, Research Kits
NativeFolder Bacterial Culture Medium
- $350.00 – $19,500.00
- Select options
-
- Sale!
- Research Kits
CycloScreen: Cyclodextrins Kit for Screening
- Original price was: $595.00.$295.00Current price is: $295.00.
- Add to cart
-
- Sale!
- Research Kits
NativePro Bradford Protein Assay Kit (Automated)
- Original price was: $995.00.$495.00Current price is: $495.00.
- Add to cart
-
- Sale!
- Interference, Research Kits
Rheumatoid Factor Interference Kit
- Original price was: $1,495.00.$695.00Current price is: $695.00.
- Add to cart
-
- Sale!
- Interference, Research Kits
Interference Test Kit EXTRA
- Original price was: $795.00.$495.00Current price is: $495.00.
- Add to cart
-
- Sale!
- Interference, Research Kits
HAMA Interference Kit
- Original price was: $895.00.$595.00Current price is: $595.00.
- Add to cart
-
- Sale!
- Buffers & Solutions, ELISA, Research Kits
ELISA Microplate Production Kit
- Original price was: $795.00.$495.00Current price is: $495.00.
- Add to cart