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Intracranial pressure monitoring in intensive care: clinical advantages of a computerized system over manual recording

机译：重症监护中的颅内压监测：计算机系统相对于手动记录的临床优势

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IntroductionThe presence of intracranial hypertension (HICP) after traumatic brain injury (TBI) affects patient outcome. Intracranial pressure (ICP) data from electronic monitoring equipment are usually calculated and recorded hourly in the clinical chart by trained nurses. Little is known, however, about how precisely this method reflects the real patterns of ICP after severe TBI. In this study, we compared hourly manual recording with a validated and continuous computerized reference standard.MethodsThirty randomly selected patients with severe TBI and HICP admitted to the neuroscience intensive care unit (Policlinico University Hospital, Milan, Italy) were retrospectively studied. A 24-hour interval with ICP monitoring was randomly selected for each patient. The manually recorded data available for analysis covered 672 hours corresponding to 36,492 digital data points. The two methods were evaluated using the correlation coefficient and the Bland and Altman method. We used the proportion test to analyze differences in the number of episodes of HICP (ICP > 20 mm Hg) detected with the two methods and the paired t test to analyze differences in the percentage of time of HICP.ResultsThere was good agreement between the digitally collected ICP and the manual recordings of the end-hour values. Bland and Altman analysis confirmed a mean difference between the two methods of 0.05 mm Hg (standard deviation 3.66); 96% of data were within the limits of agreement (+7.37 and -7.28). The average percentages of time of ICP greater than 20 mm Hg were 39% calculated from the digital measurements and 34% from the manual observations. From the continuous digital recording, we identified 351 episodes of ICP greater than 20 mm Hg lasting at least five minutes and 287 similar episodes lasting at least ten minutes. Conversely, end-hour ICP of greater than 20 mm Hg was observed in only 204 cases using manual recording methods.ConclusionAlthough manually recorded end-hour ICP accurately reflected the computerized end-hour and mean hour values, the important omission of a number of episodes of high ICP, some of long duration, results in a clinical picture that is not accurate or informative of the true pattern of unstable ICP in patients with TBI.
机译：简介脑外伤（TBI）后颅内高压（HICP）的存在会影响患者的预后。来自电子监控设备的颅内压（ICP）数据通常由训练有素的护士每小时计算一次并记录在临床图表中。但是，对于这种方法在多大的TBI之后如何精确反映ICP的实际模式知之甚少。在这项研究中，我们将每小时的手动记录与经过验证的连续计算机参考标准进行了比较。方法回顾性研究了30例随机选择的重症TBI和HICP入神经科学重症监护病房（意大利米兰的Policlinico大学医院）的患者。为每位患者随机选择24小时的ICP监测间隔。可供分析的手动记录数据涵盖了672个小时，对应于36,492个数字数据点。使用相关系数以及Bland和Altman方法评估了这两种方法。我们使用比例检验分析了两种方法检测到的HICP发作次数（ICP> 20 mm Hg）的差异，配对t检验分析了HICP时间百分比的差异。结果收集ICP并手动记录结束时间值。 Bland和Altman分析证实了这两种方法之间的平均差为0.05 mm Hg（标准差3.66）。 96％的数据在协议范围内（+7.37和-7.28）。 ICP大于20 mm Hg的平均时间百分比从数字测量值计算得出为39％，从手动观测结果计算为34％。从连续的数字记录中，我们发现ICP大于20 mm Hg的351次发作持续至少五分钟，而287次类似的发作持续至少十分钟。相反，使用手动记录方法仅在204例患者中观察到了大于20 mm Hg的末时ICP。结论尽管手动记录的末时ICP可以准确反映计算机化的末时和平均时数，但许多事件的重要遗漏高ICP的症状（持续时间较长）导致临床图像不准确或无法提供TBI患者不稳定ICP的真实模式。

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