The Intervention Threshold for Intracranial Pressure of Traumatic Brain Injury Patients Can Be Determined by Clustering Algorithms and Is Observed to Be 13 mm Hg
Clinical Medicine Research
Volume 8, Issue 1, January 2019, Pages: 6-15
Received: Jan. 21, 2019;
Accepted: Feb. 22, 2019;
Published: Mar. 12, 2019
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Hermann Prossinger, Department of Evolutionary Anthropology, Faculty of Life Sciences, University of Vienna, Vienna, Austria
Hubert Hetz, Department for Anaesthesiology and Intensive Medical Care, Trauma Center Vienna, Location Meidling, Vienna, Austria
Alexandra Acimovic, Department for Anaesthesiology and Intensive Medical Care, Trauma Center Vienna, Location Meidling, Vienna, Austria
Reinhard Berger, Department for Anaesthesiology and Intensive Medical Care, Trauma Center Vienna, Location Meidling, Vienna, Austria
Karim Mostafa, Faculty of Medicine, Sigmund Freud Private University, Vienna, Austria
Alexander Grieb, Faculty of Medicine, Sigmund Freud Private University, Vienna, Austria
Heinz Steltzer, Department for Anaesthesiology and Intensive Medical Care, Trauma Center Vienna, Location Meidling, Vienna, Austria; Faculty of Medicine, Sigmund Freud Private University, Vienna, Austria
During treatment in an intensive care unit (ICU), traumatic brain injury (TBI) patients sometimes suffer an increase in intracranial pressure (ICP). An increase beyond a currently unknown and to-be-determined threshold is very often life-threatening and requires intervention by the clinical staff. Because this threshold value is considered unknown, ‘conventional wisdom’ of practitioners argue it to be 20 mm Hg. No published studies include statistical methods that could supply a rigorous outcome for the threshold value. Here, we use a clustering algorithm (K-means clustering) to find three-dimensional clusters of the 984 triples of ICP, temperature and patient state index (PSI, a proxy for sedation level). The algorithm outputs three clusters and two gaps. One gap separates two clusters from a third and is almost planar, and perpendicular to the ICP axis (implying a threshold across all temperatures and all sedation levels); the other is perpendicular to the temperature axis, which terminates at the aforementioned gap. The first gap provides a statistically rigorous threshold of 13.625 mm Hg for ICP intervention. The second gap defines a threshold temperature (36.5°C). The gap between the two temperature regimes does not continue into Cluster 3, implying that the intervention threshold for ICP is independent of temperature.
The Intervention Threshold for Intracranial Pressure of Traumatic Brain Injury Patients Can Be Determined by Clustering Algorithms and Is Observed to Be 13 mm Hg, Clinical Medicine Research.
Vol. 8, No. 1,
2019, pp. 6-15.
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