Development of Traumatic Brain Injury Associated Intracranial Hypertension Prediction Algorithms: A Narrative Review

Abstract

Traumatic intracranial hypertension (tIH) is a common and potentially lethal complication of moderate to severe traumatic brain injury (m-sTBI). It often develops with little warning and is managed reactively with the tiered application of intracranial pressure (ICP)-lowering interventions administered in response to an ICP rising above a set threshold. For over 45 years, a variety of research groups have worked toward the development of technology to allow for the preemptive management of tIH in the hope of improving patient outcomes. In 2022, the first operationalizable tIH prediction system became a reality. With such a system, ICP lowering interventions could be administered prior to the rise in ICP, thus protecting the patient from potentially damaging tIH episodes and limiting the overall ICP burden experienced. In this review, we discuss related approaches to ICP forecasting and IH prediction algorithms, which collectively provide the foundation for the successful development of an operational tIH prediction system. We also discuss operationalization and the statistical assessment of tIH algorithms. This review will be of relevance to clinicians and researchers interested in development of this technology as well as those with a general interest in the bedside application of machine learning (ML) technology.

Keywords: intracranial hypertension; intracranial hypertension prediction; intracranial pressure forecasting; machine learning.

FIG. 1.

Illustration of MOCAIP metrics. ICP, intracranial pressure; MOCAIP, morphological clustering and analysis of intracranial pressure. Reprinted from Hu X, et al. Copyright 2010 by IEEE. Reprinted with permission.

FIG. 2.

Predictive performance parameters. Calculation of sensitivity, specificity, positive predictive value, negative predictive value, accuracy, and balanced accuracy.