Accuracy of intracranial pressure monitoring: systematic review and meta-analysis

Abstract

IntroductionIntracranial pressure (ICP) measurement is used to tailor interventions and to assist in formulating the prognosis for traumatic brain injury patients. Accurate data are therefore essential. The aim of this study was to verify the accuracy of ICP monitoring systems on the basis of a literature review.MethodsA PubMed search was conducted from 1982 to 2014, plus additional references from the selected papers. Accuracy was defined as the degree of correspondence between the pressure read by the catheter and a reference “real” ICP measurement. Studies comparing simultaneous readings from at least two catheters were included. Drift was defined as the loss of accuracy over the monitoring period. Meta-analyses of data from the studies were used to estimate the overall mean difference between simultaneous ICP measurements and their variability. Individual studies were weighted using both a fixed and a random effects model.ResultsOf 163 articles screened, 83 compared two intracranial catheters: 64 reported accuracy and 37 drift (some reported both). Of these, 10 and 17, respectively, fulfilled the inclusion criteria for accuracy and zero drift analysis. The combined mean differences between probes were 1.5 mmHg (95 % confidence interval (CI) 0.7–2.3) with the random effects model and 1.6 mmHg (95 % CI 1.3–1.9) with the fixed effects model. The reported mean drift over a long observation period was 0.75 mmHg. No relation was found with the duration of monitoring or differences between various probes.ConclusionsThis study confirms that the average error between ICP measures is clinically negligible. The random effects model, however, indicates that a high percentage of readings may vary over a wide range, with clinical implications both for future comparison studies and for daily care.

Fully automated, real-time, calibration-free, continuous noninvasive estimation of intracranial pressure in children

“…A recent meta-analysis comparing the accuracy of invasive ICP monitoring approaches showed a pooled mean difference between paired readings of 2 invasive probes of 1.5 mm Hg (95% CI 0.7-2.3 mm Hg). 22 In those studies included in the meta-analysis with 10 or more subjects, the reported SDEs ranged from 1.1 mm Hg to 7.8 mm Hg. Our model-based nICP estimation produced a bias of about 1.0 mm Hg and associated SDE of 5.1 mm Hg, which matches the clinically accepted accuracy and range of precision errors for routinely used invasive ICP monitors.…”

Long-term reliability of the telemetric Neurovent-P-tel sensor: in vivo case report

“…Many kinds of nontelemetric sensors have been used for ICP measurements, but their use for long-term monitoring is controversial because of the risk of infection through an intracranial-extracranial device and zero drift, as reported in several articles. 1,16 Also, most intraparenchymal sensors cannot be re-zeroed while recording.…”

Differentiate the Source and Site of Intracranial Pressure Measurements Using More Precise Nomenclature

“…The evidence does demonstrate that both IPM pressure monitoring and EVD pressure monitoring have advantages and disadvantages. Drift or zero loss (zero drift) has been discussed primarily for IPM; however, the most recent summary of the literature supports that mean drift is less than 1 mmHg [22]. Similarly, recent articles find that measurement techniques and anatomical reference points are not standardized and may contribute to measurement variability [16,17,23].…”