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Using Artificial Intelligence to Predict Intracranial Hypertension in Patients After Traumatic Brain Injury: A
S T van Hal1, M van der Jagt2, M E van Genderen2
1Department of Adult Intensive Care, Erasmus MC University Medical Center, Room Ne-413, Doctor Molewaterplein 40, Rotterdam, 3015 GD, The Netherlands. s.vanhal@erasmusmc.nl.
Neurocritical Care
|January 11, 2024
Summary
Artificial intelligence models can predict intracranial hypertension (IH) in traumatic brain injury patients. While some models show promise, most studies have a high risk of bias, hindering clinical integration.
Area of Science:
- Medical Informatics
- Artificial Intelligence in Medicine
- Neuroscience
Background:
- Intracranial hypertension (IH) significantly worsens outcomes in traumatic brain injury (TBI).
- Early detection and intervention are crucial, but a preemptive approach to managing IH is more beneficial.
- Artificial intelligence (AI) offers potential for developing predictive models for IH.
Approach:
- Systematic review of AI models for predicting IH or intracranial pressure (ICP) in TBI patients.
- Searched three databases until March 12, 2023, including studies with AI model validation.
- Extracted AI model type, variables, performance, validation, prediction window, risk of bias, and clinical readiness level.
Key Points:
- Gaussian processes models using ICP and mean arterial pressure were common.
- Maximum reported area under the ROC curve was 0.94; four studies performed external validation.
- Most studies (73%) exhibited a high risk of bias; the highest clinical ML readiness level achieved was 6/9.
Conclusions:
- Several AI models demonstrate good performance and external validation for IH prediction.
- Models show potential for clinical integration, with some reaching the 'real-time model testing' stage.
- Addressing the high risk of bias in current studies is essential for advancing AI in IH management.
Related Concept Videos
01:14Increased Intracranial Pressure l: Introduction
Intracranial hypertension is a sustained elevation of intracranial pressure (ICP) above 22 mm Hg. In supine adults, normal ICP is ~7–15 mm Hg.The rigid, nonexpandable cranium contains three components—brain tissue, blood, and cerebrospinal fluid (CSF)—that total ~1,700 mL in a typical adult: 1,400 mL brain (~80%), 150 mL blood (~10%), and 150 mL CSF (~10%). According to the Monro–Kellie doctrine, total intracranial volume is effectively fixed. When one component expands, CSF and venous blood...
01:29Increased Intracranial Pressure ll: Pathophysiology
Increased intracranial pressure (ICP) refers to a potentially life-threatening rise in pressure inside the skull. This usually happens when there is a major change in the volume of brain tissue, blood, or cerebrospinal fluid (CSF) — the three components inside the skull. According to the Monro-Kellie doctrine, if the volume of one component increases, the volumes of the other components must decrease to maintain normal pressure. If this does not happen, ICP rises.The process often begins with...