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

Hermann Prossinger; Hubert Hetz; Alexandra Acimovic; Reinhard Berger; Karim Mostafa; Alexander Grieb; Heinz Steltzer

doi:doi:10.11648/j.cmr.20190801.12

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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

Hermann Prossinger, Hubert Hetz, Alexandra Acimovic, Reinhard Berger, Karim Mostafa, Alexander Grieb, Heinz Steltzer

Published in Clinical Medicine Research (Volume 8, Issue 1)

Received: 21 January 2019 Accepted: 22 February 2019 Published: 12 March 2019

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Abstract

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.

Published in	Clinical Medicine Research (Volume 8, Issue 1)
DOI	10.11648/j.cmr.20190801.12
Page(s)	6-15
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2019. Published by Science Publishing Group

Keywords

Intracranial Pressure, Traumatic Brain Injury, Clustering Algorithms, Patient State Index, Akaike’s Information Criterion, ICP Intervention Threshold, K-means Clustering

References

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APA Style

Hermann Prossinger, Hubert Hetz, Alexandra Acimovic, Reinhard Berger, Karim Mostafa, et al. (2019). 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, 8(1), 6-15. https://doi.org/10.11648/j.cmr.20190801.12

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ACS Style

Hermann Prossinger; Hubert Hetz; Alexandra Acimovic; Reinhard Berger; Karim Mostafa, et al. 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. Clin. Med. Res. 2019, 8(1), 6-15. doi: 10.11648/j.cmr.20190801.12

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AMA Style

Hermann Prossinger, Hubert Hetz, Alexandra Acimovic, Reinhard Berger, Karim Mostafa, et al. 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. Clin Med Res. 2019;8(1):6-15. doi: 10.11648/j.cmr.20190801.12

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@article{10.11648/j.cmr.20190801.12,
  author = {Hermann Prossinger and Hubert Hetz and Alexandra Acimovic and Reinhard Berger and Karim Mostafa and Alexander Grieb and Heinz Steltzer},
  title = {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},
  journal = {Clinical Medicine Research},
  volume = {8},
  number = {1},
  pages = {6-15},
  doi = {10.11648/j.cmr.20190801.12},
  url = {https://doi.org/10.11648/j.cmr.20190801.12},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.cmr.20190801.12},
  abstract = {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.},
 year = {2019}
}

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TY  - JOUR
T1  - 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
AU  - Hermann Prossinger
AU  - Hubert Hetz
AU  - Alexandra Acimovic
AU  - Reinhard Berger
AU  - Karim Mostafa
AU  - Alexander Grieb
AU  - Heinz Steltzer
Y1  - 2019/03/12
PY  - 2019
N1  - https://doi.org/10.11648/j.cmr.20190801.12
DO  - 10.11648/j.cmr.20190801.12
T2  - Clinical Medicine Research
JF  - Clinical Medicine Research
JO  - Clinical Medicine Research
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EP  - 15
PB  - Science Publishing Group
SN  - 2326-9057
UR  - https://doi.org/10.11648/j.cmr.20190801.12
AB  - 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.
VL  - 8
IS  - 1
ER  -

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Author Information

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

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Hermann Prossinger, Hubert Hetz, Alexandra Acimovic, Reinhard Berger, Karim Mostafa, et al. (2019). 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, 8(1), 6-15. https://doi.org/10.11648/j.cmr.20190801.12

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ACS Style

Hermann Prossinger; Hubert Hetz; Alexandra Acimovic; Reinhard Berger; Karim Mostafa, et al. 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. Clin. Med. Res. 2019, 8(1), 6-15. doi: 10.11648/j.cmr.20190801.12

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AMA Style

Hermann Prossinger, Hubert Hetz, Alexandra Acimovic, Reinhard Berger, Karim Mostafa, et al. 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. Clin Med Res. 2019;8(1):6-15. doi: 10.11648/j.cmr.20190801.12

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@article{10.11648/j.cmr.20190801.12,
  author = {Hermann Prossinger and Hubert Hetz and Alexandra Acimovic and Reinhard Berger and Karim Mostafa and Alexander Grieb and Heinz Steltzer},
  title = {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},
  journal = {Clinical Medicine Research},
  volume = {8},
  number = {1},
  pages = {6-15},
  doi = {10.11648/j.cmr.20190801.12},
  url = {https://doi.org/10.11648/j.cmr.20190801.12},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.cmr.20190801.12},
  abstract = {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.},
 year = {2019}
}

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TY  - JOUR
T1  - 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
AU  - Hermann Prossinger
AU  - Hubert Hetz
AU  - Alexandra Acimovic
AU  - Reinhard Berger
AU  - Karim Mostafa
AU  - Alexander Grieb
AU  - Heinz Steltzer
Y1  - 2019/03/12
PY  - 2019
N1  - https://doi.org/10.11648/j.cmr.20190801.12
DO  - 10.11648/j.cmr.20190801.12
T2  - Clinical Medicine Research
JF  - Clinical Medicine Research
JO  - Clinical Medicine Research
SP  - 6
EP  - 15
PB  - Science Publishing Group
SN  - 2326-9057
UR  - https://doi.org/10.11648/j.cmr.20190801.12
AB  - 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.
VL  - 8
IS  - 1
ER  -

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