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We evaluated the pulse shape index (PSI) against the tidal wave (P2)\/percussion wave (P1) ratio and examined the contributions of pulse amplitude, compensatory reserve [pressure\u2013volume compensatory reserve index (RAP)] and transcranial Doppler (TCD)-derived indices.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A total of 4388 non-overlapping 5-min segments from 96 high-resolution recordings of simultaneous ICP and TCD blood velocity were analysed. PSI and P2\/P1 were derived from normalised ICP pulses. ICP pulse amplitude (AMP), RAP and TCD-derived arterial and intracranial compliance indices [arterial compliance (C\n                      <jats:sub>A<\/jats:sub>\n                      ), intracranial compliance (C\n                      <jats:sub>I<\/jats:sub>\n                      )] were calculated per segment. Associations were assessed at segment, recording, and patient levels using correlation and mixed-effects models. Discriminatory performance for impaired (P2\/P1\u2009&gt;\u20091.1) and preserved (P2\/P1\u2009&lt;\u20090.9) compliance was evaluated using receiver operating characteristic (ROC) and precision\u2013recall analyses. Concordance between PSI and P2\/P1 classifications was assessed using Chi-squared threshold mapping.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      PSI demonstrated a strong association with P2\/P1 (\n                      <jats:italic>r<\/jats:italic>\n                      \u2248 0.74\u20130.76 across analysis levels) and high discrimination for impaired compliance [area under the curve (AUC) \u2248 0.93]. RAP and C\n                      <jats:sub>I<\/jats:sub>\n                      showed weak and inconsistent population-level associations with P2\/P1, with substantial inter-individual variability. A distinct phenotype of low AMP (&lt;\u20091.5 mm Hg) despite impaired waveform-derived compliance was associated with lower RAP. C\n                      <jats:sub>A<\/jats:sub>\n                      and C\n                      <jats:sub>I<\/jats:sub>\n                      provided limited incremental explanatory value, whereas inclusion of AMP improved model fit and classification performance beyond morphology-based metrics alone.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>PSI closely reflects P2\/P1 and supports automated waveform-based compliance assessment. However, morphology alone is insufficient; amplitude and reserve indices provide complementary information, supporting a multiparametric approach to intracranial monitoring.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s12028-026-02620-1","type":"journal-article","created":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T16:26:49Z","timestamp":1785774409000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Waveform-Derived Metrics of Intracranial Compliance: Validation and Pulsatile Dynamics"],"prefix":"10.1007","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-8283-305X","authenticated-orcid":false,"given":"Ihsane","family":"Olakorede","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan Yu","family":"B\u00f6gli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marek","family":"Czosnyka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Smielewski","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,8,3]]},"reference":[{"issue":"12","key":"2620_CR1","doi-asserted-by":"publisher","first-page":"1746","DOI":"10.1212\/wnl.56.12.1746","volume":"56","author":"B Mokri","year":"2001","unstructured":"Mokri B. 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The other authors declare no financial or nonfinancial conflicts of interest. Marek Czosnyka holds the position of senior scientific advisor for Brain4Care.","order":1,"name":"Ethics","label":"Conflict of interest","group":{"name":"EthicsHeading","label":"Ethics"}},{"value":"This study used retrospective data from the Brain Physics database, approved by the Yorkshire & The Humber\u2014Leeds East Research Ethics Committee (REC 23\/YH\/0085; IRAS ID: 320219) in April 2023. Multimodality monitoring was undertaken as part of routine clinical practice, and transcranial Doppler assessments were performed within a prospective clinical audit (Clinical Project ID4201\u2013TCD-based assessment of intracranial hemodynamics in patients admitted to NCCU). The requirement for informed consent was waived by the local ethics authorities. All procedures were carried out in accordance with the Declaration of Helsinki and relevant local regulations.","order":2,"name":"Ethics","label":"Ethical Approval\/Informed Consent","group":{"name":"EthicsHeading","label":"Ethics"}},{"value":"The authors used generative artificial intelligence (AI) tools to improve readability and correct grammar. The authors reviewed and edited the content as needed and take ultimate responsibility for the content of the publication.","order":3,"name":"Ethics","label":"Artificial Intelligence","group":{"name":"EthicsHeading","label":"Ethics"}}]}}