Related Experiment Video
Updated: Aug 7, 2025
A Bedside, Single Burr Hole Approach to Multimodality Monitoring in Severe Brain Injury
Published on: March 26, 2019
Studying Trends of Auto-Regulation in Severe Head Injury in Paediatrics (STARSHIP): protocol to study cerebral
Shruti Agrawal1,2, Michal M Placek3, Deborah White2
1Department of Paediatrics, Cambridge University, Cambridge, UK shruti.agrawal1@nhs.net.
Insights
This study establishes a protocol for assessing cerebral autoregulation using the Pressure Reactivity Index (PRx) in pediatric traumatic brain injury (PTBI). The research aims to identify optimal PRx thresholds linked to better outcomes in children with PTBI.
Area of Science:
- Neuroscience
- Critical Care Medicine
- Pediatric Neurology
Background:
- Cerebral autoregulation monitoring, particularly Pressure Reactivity Index (PRx), is vital in adult traumatic brain injury (TBI) for real-time intracranial pathophysiology insights.
- Paediatric TBI (PTBI) has a disproportionately high morbidity and mortality rate compared to adult TBI, yet research is limited to single-centre studies.
Purpose of the Study:
- To describe a protocol for studying cerebral autoregulation using PRx in PTBI.
- To establish a multicentre prospective research database for PTBI neuromonitoring data.
- To identify optimal PRx thresholds associated with favorable outcomes in PTBI.
Main Methods:
- A multicentre prospective study involving 10 UK centres, recruiting 135 patients with PTBI.
- Data collection includes high-resolution neuromonitoring waveforms and 1-year outcome follow-up.
- Secondary objectives involve characterizing optimal cerebral perfusion pressure patterns and correlating them with outcomes.
Main Results:
- The study protocol is established and ethics-approved for a multicentre PTBI research database.
- Recruitment is ongoing, with a target of 135 patients and 1-year outcome follow-up.
- The database will provide comprehensive neuromonitoring data for scientific use in PTBI.
Conclusions:
- This multicentre study protocol will generate crucial data on cerebral autoregulation in PTBI.
- Understanding PRx in pediatric patients can improve management and outcomes for TBI.
- The established database will facilitate future research in pediatric neurocritical care.
Introduction:
Studying cerebral autoregulation, particularly PRx (Pressure Reactivity Index), is commonly employed in adult traumatic brain injury (TBI) and gives real-time information about intracranial pathophysiology, which can help in patient management. Experience in paediatric TBI (PTBI) is limited to single-centre studies despite disproportionately higher incidence of morbidity and mortality in PTBI than in adult TBI.
Project:
We describe the protocol to study cerebral autoregulation using PRx in PTBI. The project called Studying Trends of Auto-Regulation in Severe Head Injury in Paediatrics is a multicentre prospective ethics approved research database study from 10 centres across the UK. Recruitment started in July 2018 with financial support from local/national charities (Action Medical Research for Children, UK).
Methods And Analysis:
The first phase of the project is powered to detect optimal thresholds of PRx associated with favourable outcome in PTBI by recruiting 135 patients (initial target of 3 years which has changed to 5 years due to delays related to COVID-19 pandemic) from 10 centres in the UK with outcome follow-up to 1-year postictus. The secondary objectives are to characterise patterns of optimal cerebral perfusion pressure in PTBI and compare the fluctuations in these measured parameters with outcome. The goal is to create a comprehensive research database of a basic set of high-resolution (full waveforms resolution) neuromonitoring data in PTBI for scientific use.
Ethics And Dissemination:
Favourable ethical approval has been provided by Health Research Authority, Southwest-Central Bristol Research Ethics Committee (Ref: 18/SW/0053). Results will be disseminated via publications in peer-reviewed medical journals and presentations at national and international conferences.
Trial Registration Number:
NCT05688462.
