Clinical Validation of a Transcranial Doppler-Based Noninvasive Intracranial Pressure Meter: A Prospective Cross-Sectional Study

Noninvasive intracranial pressure (ICP) measurement would represent a major advance for patients with neurological problems. The Vittamed ICP meter is an ultrasound-based device reported to have high agreement with lumbar puncture cerebrospinal fluid (CSF) pressure measurement. However, previous stu...

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Bibliographic Details
Published in:World neurosurgery Vol. 89; pp. 647 - 653.e1
Main Authors: Bershad, Eric M., Anand, Aashish, DeSantis, Stacia M., Yang, Ming, Tang, Rosa A., Calvillo, Eusebia, Malkin-Gosdin, Leslie, Foroozan, Rod, Damani, Rahul, Maldonado, Nelson, Gupta, Pramod, Tan, Benedict, Venkatasubba Rao, Chethan P., Suarez, Jose I., Clark, Jonathan B., Sutton, Jeffrey P., Donoviel, Dorit B.
Format: Journal Article
Language:English
Published: United States Elsevier Inc 01.05.2016
Subjects:
Adolescent
Adult
Aged
Cross-Sectional Studies
Female
Humans
Intracranial Hypertension - diagnosis
Intracranial pressure
Intracranial Pressure - physiology
Intraocular Pressure - physiology
Male
Middle Aged
Nervous System Diseases - diagnostic imaging
Nervous System Diseases - physiopathology
Neurocritical care
Neurosurgery
Noninvasive
Prospective Studies
ROC Curve
Spinal Puncture
Transcranial Doppler ultrasound
Ultrasonography, Doppler, Transcranial - methods
Vittamed
Young Adult
LP
IIH
Intracranial pressure
Neurocritical care
Vittamed
IOP
AUC
Transcranial Doppler ultrasound
OA
TCD
Pe
ICP
Noninvasive
Transcranial Doppler
Lumbar puncture
Ophthalmic artery
Area under the curve
Idiopathic intracranial hypertension
External pressure
Intraocular pressure
ISSN:1878-8750, 1878-8769, 1878-8769
Online Access:Get full text
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Summary:Noninvasive intracranial pressure (ICP) measurement would represent a major advance for patients with neurological problems. The Vittamed ICP meter is an ultrasound-based device reported to have high agreement with lumbar puncture cerebrospinal fluid (CSF) pressure measurement. However, previous studies included mostly patients with normal levels of ICP. The purpose of our study was to perform an independent clinical validation study of a transcranial Doppler-based noninvasive ICP meter in patients anticipated to have a wide range of ICP. In a prospective cross-sectional design, we simultaneously measured ICP with the Vittamed device and the invasive lumbar CSF pressure. The operator of each procedure was blinded to the result of the other method. Data were analyzed using Bland-Altman plots, Pearson correlation coefficients, and receiver operator characteristic curves. Twenty-four independent paired measurements of Vittamed and lumbar CSF pressure were obtained; with mean absolute difference between paired measures of 4.5 mmHg (standard deviation 3.1). The 95% limits of agreement were −10.5 to +11.0. The systematic bias (mean of paired differences) was negligible at 0.25 mmHg. The sensitivity, specificity, and area under the curve for ICP >20 mmHg were 0.73, 0.77, and 0.71, respectively. The Vittamed ICP meter had fair agreement with lumbar CSF pressure measurement. The wide limits of agreement would preclude using this version of the device as a stand-alone method for ICP determination, but may be useful if combined with other ICP screening methods. Ongoing improvements to the Vittamed hardware and software may lead to improvements in accuracy and clinical utility of this device.
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ISSN:1878-8750
1878-8769
1878-8769
DOI:10.1016/j.wneu.2015.11.102