{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T01:12:59Z","timestamp":1792026779091,"version":"4.4.0"},"reference-count":26,"publisher":"Springer Science and Business Media LLC","issue":"2","license":[{"start":{"date-parts":[[2025,4,28]],"date-time":"2025-04-28T00:00:00Z","timestamp":1745798400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,4,28]],"date-time":"2025-04-28T00:00:00Z","timestamp":1745798400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Neurocrit Care"],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Background<\/jats:title>\n            <jats:p>Noninvasive methods for detecting intracranial hypertension (IH) are of growing importance in clinical settings. This study evaluates the clinical performance of the brain4care (B4C) System, which captures pulsatile cranial expansions that reveal a surrogate intracranial pressure (ICP) waveform and subsequently derives the P2\/P1 ratio and time-to-peak (TTP) parameters to predict IH.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>This was a retrospective study conducted across multiple centers that included a total of 124 patients. Invasively monitored ICP and noninvasive B4C waveforms were recorded simultaneously from patients with acute brain injuries. Data were analyzed using specific cutoff values for the estimated P2\/P1 ratio (ranging from 0.8 to 1.4) and TTP (at 0.3) to assess their diagnostic accuracy. Sensitivity and specificity for detecting IH (ICP\u2009&gt;\u200920\u00a0mm Hg) were determined based on these metrics.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>The estimated P2\/P1 ratio demonstrated a sensitivity of 92% and specificity of 19% at a threshold of 0.8, indicating high sensitivity for ruling out IH. At a ratio of 1.4, the specificity improved to 90%, suggesting its effectiveness for assessing IH. For TTP, a threshold of 0.3 was identified as the optimal cutoff, offering a specificity of 92%.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>The B4C System provides a viable, noninvasive approach to assessing IH. The study underscores the clinical utility of the P2\/P1 ratio and TTP in detecting and ruling out IH, offering a significant alternative to invasive ICP monitoring methods.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1007\/s12028-025-02273-6","type":"journal-article","created":{"date-parts":[[2025,4,28]],"date-time":"2025-04-28T10:17:38Z","timestamp":1745835458000},"page":"628-635","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Clinical Performance of the Brain4care System for Noninvasive Detection of Intracranial Hypertension"],"prefix":"10.1007","volume":"43","author":[{"given":"Gustavo","family":"Frigieri","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thauan Leandro","family":"Gon\u00e7alves","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriela Nagai","family":"Ocamoto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rodrigo","family":"de AP Andrade","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruno Cezar","family":"de Padua","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9261-1321","authenticated-orcid":false,"given":"Danilo","family":"Cardim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,4,28]]},"reference":[{"key":"2273_CR1","doi-asserted-by":"publisher","DOI":"10.1186\/s12987-020-00195-3","author":"KB Evensen","year":"2020","unstructured":"Evensen KB, Eide PK. 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DC is brain4care\u2019s research director. TLG, GNO, and BCP are employees at brain4care.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflicts of interest"}},{"value":"The authors confirm compliance with ethical approval and informed consent for human studies. The study was conducted in accordance with the Declaration of Helsinki and with local regulations. The study obtained ethics approval from the University of S\u00e3o Paulo and Hospital Jo\u00e3o XXIII, under the reference number 6150621, CAAE: 39348920.1.1001.0068; Federal University of S\u00e3o Paulo, under the reference number 3.129.120, CAAE: 03843118.0.0000.5505; Hospital Estadual de Emerg\u00eancia e Trauma Senador Humberto Lucena, under the reference number 5.078.425, CAAE: 39348920.1.2001.5186; University of Porto, under the reference number 106\u201317; Stanford University, under the reference number 46100. All participants or their legally authorized representative received all required information regarding study procedures.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}}]}}