Status of cerebrovascular autoregulation relates to outcome in severe paediatric head injury: STARSHIP, a prospective multicentre validation studyResearch in context
Summary: Background: Continuous assessment of cerebral autoregulation (CA) using pressure reactivity index (PRx), is a promising tool for individualized management to improve outcome after traumatic brain injury (TBI). However, experience with CA in paediatric TBI (pTBI) is limited to retrospective...
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2025-03-01
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| author | Shruti Agrawal Claudia Smith Stefan Y. Bogli Michal M. Placek Manuel Cabeleira Deborah White Esther Daubney Adam Young Erta Beqiri Riaz Kayani Diarmuid O'Donnell Nazima Pathan Suzanna Watson Anna Maw Matthew Ganrett Hari Krishan Kanthimathianathan Harish Bangalore Santosh Sundararajan Gayathri Subramanian Dusan Raffaj Avishay Sarfatti Simona Lampareillo Anton Mayer Oliver Ross Marek Czosnyka Peter J. Hutchinson Peter Smielewski Carly Tooke Caroline Payne Holly Belfield Amisha Mistry Collette Spencer Claire Jennings Lara Bunni Laura Anderson Emily Morgan Melanie James Rebecca Beckley Tahnima Khatun Hafiza Khatun Olivia Nugent Richard Aldridge Ruth Morgan Julie Morcombe Martin Quinton Catherine Postlethwaite Jenny Pond Jessica Cutler Caitlin Oxford |
| author_facet | Shruti Agrawal Claudia Smith Stefan Y. Bogli Michal M. Placek Manuel Cabeleira Deborah White Esther Daubney Adam Young Erta Beqiri Riaz Kayani Diarmuid O'Donnell Nazima Pathan Suzanna Watson Anna Maw Matthew Ganrett Hari Krishan Kanthimathianathan Harish Bangalore Santosh Sundararajan Gayathri Subramanian Dusan Raffaj Avishay Sarfatti Simona Lampareillo Anton Mayer Oliver Ross Marek Czosnyka Peter J. Hutchinson Peter Smielewski Carly Tooke Caroline Payne Holly Belfield Amisha Mistry Collette Spencer Claire Jennings Lara Bunni Laura Anderson Emily Morgan Melanie James Rebecca Beckley Tahnima Khatun Hafiza Khatun Olivia Nugent Richard Aldridge Ruth Morgan Julie Morcombe Martin Quinton Catherine Postlethwaite Jenny Pond Jessica Cutler Caitlin Oxford |
| author_sort | Shruti Agrawal |
| collection | DOAJ |
| description | Summary: Background: Continuous assessment of cerebral autoregulation (CA) using pressure reactivity index (PRx), is a promising tool for individualized management to improve outcome after traumatic brain injury (TBI). However, experience with CA in paediatric TBI (pTBI) is limited to retrospective or single-centre studies. Methods: Studying Trends of AutoRegulation in Severe Head Injury in Paediatrics (STARSHIP) (clinicalTrials.gov identifier-NCT0688462), was a prospective, multicentre, observational, research database study conducted across 10 identified UK Paediatric Intensive Care Units from 01.07.2018 till 31.04.2024. The main objective was to validate and identify optimal thresholds of PRx associated with outcome (as assessed with Glasgow outcome scale extended for Pediatrics at 12 months) in children (<16 years) requiring invasive arterial blood pressure and intracranial pressure monitoring for TBI and establish a comprehensive research database. Apart from high-resolution data, clinical and outcome data up to 12 months post-ictus were collected. Univariable and multivariable analyses including propensity score matching, were employed to determine the effect of PRx on outcome whilst considering covariates, centre-specific differences and other multimodal metrics. Findings: Out of 153 recruited, 135 children (median age 96 months) with consent and adequate data were included. Overall median PRx of the cohort was −0.09 (IQR −0.19 to 0.08). Both ICP and PRx were elevated in non-survivors and children with unfavourable outcome. PRx retained a significant effect on outcome after adjusting for various clinical and monitoring variables. The critical PRx threshold identified were 0.5 for mortality and 0.0 for favourable outcome. Interpretation: With STARSHIP, we validate the outcome association of CA derangements as assessed by PRx in pTBI in the first prospective observational multicentre study. This provides additional evidence for the potential use of PRx for individualizing prognosis and treatment and pave way for further research in pTBI with the created database. Funding: This study was funded by Action Medical Research for Children's Charity and Addenbrookes Charitable Trust, UK (Grant number-GN2609). Cambridge University Hospitals is the study sponsor (Reference: A094693, contact person: Michelle [email protected]). |
| format | Article |
| id | doaj-art-cf2dc8c04fcc4d579d0b091fe1237521 |
| institution | Kabale University |
| issn | 2589-5370 |
| language | English |
| publishDate | 2025-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | EClinicalMedicine |
| spelling | doaj-art-cf2dc8c04fcc4d579d0b091fe12375212025-02-07T04:48:06ZengElsevierEClinicalMedicine2589-53702025-03-0181103077Status of cerebrovascular autoregulation relates to outcome in severe paediatric head injury: STARSHIP, a prospective multicentre validation studyResearch in contextShruti Agrawal0Claudia Smith1Stefan Y. Bogli2Michal M. Placek3Manuel Cabeleira4Deborah White5Esther Daubney6Adam Young7Erta Beqiri8Riaz Kayani9Diarmuid O'Donnell10Nazima Pathan11Suzanna Watson12Anna Maw13Matthew Ganrett14Hari Krishan Kanthimathianathan15Harish Bangalore16Santosh Sundararajan17Gayathri Subramanian18Dusan Raffaj19Avishay Sarfatti20Simona Lampareillo21Anton Mayer22Oliver Ross23Marek Czosnyka24Peter J. Hutchinson25Peter Smielewski26Carly TookeCaroline PayneHolly BelfieldAmisha MistryCollette SpencerClaire JenningsLara BunniLaura AndersonEmily MorganMelanie JamesRebecca BeckleyTahnima KhatunHafiza KhatunOlivia NugentRichard AldridgeRuth MorganJulie MorcombeMartin QuintonCatherine PostlethwaiteJenny PondJessica CutlerCaitlin OxfordDepartment of Paediatrics, University of Cambridge, Cambridge, UK; Paediatric Intensive Care, Cambridge University Hospitals, Cambridge, UK; Corresponding author. Department of Paediatrics, University of Cambridge, PICU, Level 3, Box 7, Cambridge University Hospitals, Cambridge, CB2 0QQ, UK.Department of Clinical Neurosciences, University of Cambridge, Cambridge, UKDepartment of Clinical Neurosciences, University of Cambridge, Cambridge, UKDepartment of Clinical Neurosciences, University of Cambridge, Cambridge, UKDepartment of Clinical Neurosciences, University of Cambridge, Cambridge, UK; Department of Mechanical Engineering, University College London, London, UKDepartment of Paediatrics, University of Cambridge, Cambridge, UK; Paediatric Intensive Care, Cambridge University Hospitals, Cambridge, UKDepartment of Paediatrics, University of Cambridge, Cambridge, UK; Paediatric Intensive Care, Cambridge University Hospitals, Cambridge, UKDepartment of Clinical Neurosciences, University of Cambridge, Cambridge, UKDepartment of Clinical Neurosciences, University of Cambridge, Cambridge, UKPaediatric Intensive Care, Cambridge University Hospitals, Cambridge, UKPaediatric Intensive Care, Cambridge University Hospitals, Cambridge, UKDepartment of Paediatrics, University of Cambridge, Cambridge, UK; Paediatric Intensive Care, Cambridge University Hospitals, Cambridge, UKPaediatric Neuropsychology, Cambridge and Peterborough NHS Foundation Trust, Cambridge, UKDepartment of Paediatrics, University of Cambridge, Cambridge, UKDepartment of Clinical Neurosciences, University of Cambridge, Cambridge, UKPaediatric Intensive Care, Birmingham Children's Hospital, Birmingham, UKPaediatric Intensive Care, Great Ormond Street Hospital, London, UKPaediatric Intensive Care, Leeds Children's Hospital, Leeds, UKPaediatric Intensive Care, Manchester Children's Hospital, Manchester, UKPaediatric Intensive Care, Nottingham Children's Hospital, Nottingham, UKPaediatric Intensive Care, Oxford University Hospitals, Oxford, UKPaediatric Intensive Care, Royal London Hospital, London, UKPaediatric Intensive Care, Sheffield Children's Hospital, Sheffield, UKPaediatric Intensive Care, Southampton General Hospital, Southampton, UKDepartment of Clinical Neurosciences, University of Cambridge, Cambridge, UKDepartment of Clinical Neurosciences, University of Cambridge, Cambridge, UKDepartment of Clinical Neurosciences, University of Cambridge, Cambridge, UKSummary: Background: Continuous assessment of cerebral autoregulation (CA) using pressure reactivity index (PRx), is a promising tool for individualized management to improve outcome after traumatic brain injury (TBI). However, experience with CA in paediatric TBI (pTBI) is limited to retrospective or single-centre studies. Methods: Studying Trends of AutoRegulation in Severe Head Injury in Paediatrics (STARSHIP) (clinicalTrials.gov identifier-NCT0688462), was a prospective, multicentre, observational, research database study conducted across 10 identified UK Paediatric Intensive Care Units from 01.07.2018 till 31.04.2024. The main objective was to validate and identify optimal thresholds of PRx associated with outcome (as assessed with Glasgow outcome scale extended for Pediatrics at 12 months) in children (<16 years) requiring invasive arterial blood pressure and intracranial pressure monitoring for TBI and establish a comprehensive research database. Apart from high-resolution data, clinical and outcome data up to 12 months post-ictus were collected. Univariable and multivariable analyses including propensity score matching, were employed to determine the effect of PRx on outcome whilst considering covariates, centre-specific differences and other multimodal metrics. Findings: Out of 153 recruited, 135 children (median age 96 months) with consent and adequate data were included. Overall median PRx of the cohort was −0.09 (IQR −0.19 to 0.08). Both ICP and PRx were elevated in non-survivors and children with unfavourable outcome. PRx retained a significant effect on outcome after adjusting for various clinical and monitoring variables. The critical PRx threshold identified were 0.5 for mortality and 0.0 for favourable outcome. Interpretation: With STARSHIP, we validate the outcome association of CA derangements as assessed by PRx in pTBI in the first prospective observational multicentre study. This provides additional evidence for the potential use of PRx for individualizing prognosis and treatment and pave way for further research in pTBI with the created database. Funding: This study was funded by Action Medical Research for Children's Charity and Addenbrookes Charitable Trust, UK (Grant number-GN2609). Cambridge University Hospitals is the study sponsor (Reference: A094693, contact person: Michelle [email protected]).http://www.sciencedirect.com/science/article/pii/S2589537025000094Paediatric traumatic brain injuryCerebral autoregulationPressure reactivity index (PRx)Cerebral perfusion pressure (CPP) |
| spellingShingle | Shruti Agrawal Claudia Smith Stefan Y. Bogli Michal M. Placek Manuel Cabeleira Deborah White Esther Daubney Adam Young Erta Beqiri Riaz Kayani Diarmuid O'Donnell Nazima Pathan Suzanna Watson Anna Maw Matthew Ganrett Hari Krishan Kanthimathianathan Harish Bangalore Santosh Sundararajan Gayathri Subramanian Dusan Raffaj Avishay Sarfatti Simona Lampareillo Anton Mayer Oliver Ross Marek Czosnyka Peter J. Hutchinson Peter Smielewski Carly Tooke Caroline Payne Holly Belfield Amisha Mistry Collette Spencer Claire Jennings Lara Bunni Laura Anderson Emily Morgan Melanie James Rebecca Beckley Tahnima Khatun Hafiza Khatun Olivia Nugent Richard Aldridge Ruth Morgan Julie Morcombe Martin Quinton Catherine Postlethwaite Jenny Pond Jessica Cutler Caitlin Oxford Status of cerebrovascular autoregulation relates to outcome in severe paediatric head injury: STARSHIP, a prospective multicentre validation studyResearch in context EClinicalMedicine Paediatric traumatic brain injury Cerebral autoregulation Pressure reactivity index (PRx) Cerebral perfusion pressure (CPP) |
| title | Status of cerebrovascular autoregulation relates to outcome in severe paediatric head injury: STARSHIP, a prospective multicentre validation studyResearch in context |
| title_full | Status of cerebrovascular autoregulation relates to outcome in severe paediatric head injury: STARSHIP, a prospective multicentre validation studyResearch in context |
| title_fullStr | Status of cerebrovascular autoregulation relates to outcome in severe paediatric head injury: STARSHIP, a prospective multicentre validation studyResearch in context |
| title_full_unstemmed | Status of cerebrovascular autoregulation relates to outcome in severe paediatric head injury: STARSHIP, a prospective multicentre validation studyResearch in context |
| title_short | Status of cerebrovascular autoregulation relates to outcome in severe paediatric head injury: STARSHIP, a prospective multicentre validation studyResearch in context |
| title_sort | status of cerebrovascular autoregulation relates to outcome in severe paediatric head injury starship a prospective multicentre validation studyresearch in context |
| topic | Paediatric traumatic brain injury Cerebral autoregulation Pressure reactivity index (PRx) Cerebral perfusion pressure (CPP) |
| url | http://www.sciencedirect.com/science/article/pii/S2589537025000094 |
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