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Dynamic Intracranial Pressure Waveform Morphology Predicts Ventriculitis.
Megjhani, Murad; Terilli, Kalijah; Kalasapudi, Lakshman; Chen, Justine; Carlson, John; Miller, Serenity; Badjatia, Neeraj; Hu, Peter; Velazquez, Angela; Roh, David J; Agarwal, Sachin; Claassen, Jan; Connolly, E S; Hu, Xiao; Morris, Nicholas; Park, Soojin.
Afiliação
  • Megjhani M; Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons, 177 Fort Washington Ave, 8 Milstein - 300 Center, New York, NY, USA.
  • Terilli K; Program for Hospital and Intensive Care Informatics, Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA.
  • Kalasapudi L; Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons, 177 Fort Washington Ave, 8 Milstein - 300 Center, New York, NY, USA.
  • Chen J; Program for Hospital and Intensive Care Informatics, Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA.
  • Carlson J; Department of Neurology, Program in Trauma, University of Maryland School of Medicine, Baltimore, MD, USA.
  • Miller S; Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons, 177 Fort Washington Ave, 8 Milstein - 300 Center, New York, NY, USA.
  • Badjatia N; New York Presbyterian Hospital, Columbia University Irving Medical Center, New York, NY, USA.
  • Hu P; Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons, 177 Fort Washington Ave, 8 Milstein - 300 Center, New York, NY, USA.
  • Velazquez A; Program for Hospital and Intensive Care Informatics, Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA.
  • Roh DJ; Department of Anesthesia, Program in Trauma, University of Maryland School of Medicine, Baltimore, MD, USA.
  • Agarwal S; Department of Neurology, Program in Trauma, University of Maryland School of Medicine, Baltimore, MD, USA.
  • Claassen J; Department of Anesthesia, Program in Trauma, University of Maryland School of Medicine, Baltimore, MD, USA.
  • Connolly ES; Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons, 177 Fort Washington Ave, 8 Milstein - 300 Center, New York, NY, USA.
  • Hu X; Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons, 177 Fort Washington Ave, 8 Milstein - 300 Center, New York, NY, USA.
  • Morris N; New York Presbyterian Hospital, Columbia University Irving Medical Center, New York, NY, USA.
  • Park S; Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons, 177 Fort Washington Ave, 8 Milstein - 300 Center, New York, NY, USA.
Neurocrit Care ; 36(2): 404-411, 2022 04.
Article em En | MEDLINE | ID: mdl-34331206
ABSTRACT

BACKGROUND:

Intracranial pressure waveform morphology reflects compliance, which can be decreased by ventriculitis. We investigated whether morphologic analysis of intracranial pressure dynamics predicts the onset of ventriculitis.

METHODS:

Ventriculitis was defined as culture or Gram stain positive cerebrospinal fluid, warranting treatment. We developed a pipeline to automatically isolate segments of intracranial pressure waveforms from extraventricular catheters, extract dominant pulses, and obtain morphologically similar groupings. We used a previously validated clinician-supervised active learning paradigm to identify metaclusters of triphasic, single-peak, or artifactual peaks. Metacluster distributions were concatenated with temperature and routine blood laboratory values to create feature vectors. A L2-regularized logistic regression classifier was trained to distinguish patients with ventriculitis from matched controls, and the discriminative performance using area under receiver operating characteristic curve with bootstrapping cross-validation was reported.

RESULTS:

Fifty-eight patients were included for analysis. Twenty-seven patients with ventriculitis from two centers were identified. Thirty-one patients with catheters but without ventriculitis were selected as matched controls based on age, sex, and primary diagnosis. There were 1590 h of segmented data, including 396,130 dominant pulses in patients with ventriculitis and 557,435 pulses in patients without ventriculitis. There were significant differences in metacluster distribution comparing before culture-positivity versus during culture-positivity (p < 0.001) and after culture-positivity (p < 0.001). The classifier demonstrated good discrimination with median area under receiver operating characteristic 0.70 (interquartile range 0.55-0.80). There were 1.5 true alerts (ventriculitis detected) for every false alert.

CONCLUSIONS:

Intracranial pressure waveform morphology analysis can classify ventriculitis without cerebrospinal fluid sampling.
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Texto completo: 1 Base de dados: MEDLINE Assunto principal: Ventriculite Cerebral Tipo de estudo: Diagnostic_studies / Prognostic_studies / Risk_factors_studies Limite: Humans Idioma: En Revista: Neurocrit Care Assunto da revista: NEUROLOGIA / TERAPIA INTENSIVA Ano de publicação: 2022 Tipo de documento: Article País de afiliação: Estados Unidos

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Ventriculite Cerebral Tipo de estudo: Diagnostic_studies / Prognostic_studies / Risk_factors_studies Limite: Humans Idioma: En Revista: Neurocrit Care Assunto da revista: NEUROLOGIA / TERAPIA INTENSIVA Ano de publicação: 2022 Tipo de documento: Article País de afiliação: Estados Unidos