{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T22:53:15Z","timestamp":1790981595517,"version":"4.1.0"},"reference-count":26,"publisher":"Ovid Technologies (Wolters Kluwer Health)","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"\n Objective:<\/jats:title>\n Traumatic brain injury (TBI) research and intracranial pressure (ICP) management depends on bedside ICP (B-ICP) crisis identification. We analyzed background-collected electronic ICP (E-ICP) data to study the concordance of this identification.<\/jats:p>\n <\/jats:sec>\n \n Design:<\/jats:title>\n Post hoc comparison of background-collected continuous E-ICP data to routine B-ICP information during severe TBI management in the Brain Tissue Oxygen Monitoring and Management in Severe TBI (BOOST II) randomized trial.<\/jats:p>\n <\/jats:sec>\n \n Setting:<\/jats:title>\n Ten U.S. ICUs.<\/jats:p>\n <\/jats:sec>\n \n Patients:<\/jats:title>\n Seventy of 110 randomized BOOST II severe TBI patients with complete datasets for this study.<\/jats:p>\n <\/jats:sec>\n \n Interventions:<\/jats:title>\n None.<\/jats:p>\n <\/jats:sec>\n \n Measurements and Main Results:<\/jats:title>\n \n We studied \u201dminimalist\u201d B-ICP episodes lasting less than or equal to 60 minutes and requiring only tier 1 treatments (83% of total BOOST II I isolated ICP episodes). Bedside clinicians (BCs) identified and treated 509 minimalist B-ICP episodes, defined by 5 minutes of B-ICP greater than or equal to 20\u2009mm Hg (B-ICP\n 5<\/jats:sub>\n ). Corresponding E-ICP during this defining period (E-ICP\n 5<\/jats:sub>\n ) confirmed only 47% of these. The 241 \u201cconcordant\u201d B-ICP episodes (both B-ICP\n 5<\/jats:sub>\n and E-ICP\n 5<\/jats:sub>\n \u2265 20\u2009mm Hg) had average E-ICP values for the entire B-ICP episodes (E-ICP\n AVG<\/jats:sub>\n ) less than 20\u2009mm Hg in 38%. The 286 \u201cdiscordant\u201d B-ICP episodes (B-ICP\n 5<\/jats:sub>\n \u2265 20\u2009mm Hg but E-ICP\n 5<\/jats:sub>\n < 20\u2009mm Hg) had E-ICP\n AVG<\/jats:sub>\n values less than 20\u2009mm Hg in 76% and both E-ICP\n AVG<\/jats:sub>\n and maximal E-ICP\u2019s (E-ICP\n MAX<\/jats:sub>\n ) values less than 20\u2009mm Hg in 31%. Testing for confounding (e.g., brief, first, or easily controlled B-ICP episodes) did not provide explanations. Insufficient data were available to evaluate temporal asynchrony between BC and electronic datapoints. Study limitations were lacking a rigid end-of-B-ICP episode definition and inability to fully control for temporal synchrony confounding.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions:<\/jats:title>\n Our findings suggest that current methods of clinical identification of B-ICP episodes may not reliably distinguish true episodes of sustained ICP for the most common B-ICP episode type. We suggest developing open-source, real-time, temporally synchronized electronic B-ICP episode definition methods to direct future treatment and research.<\/jats:p>\n <\/jats:sec>","DOI":"10.1097\/ccm.0000000000007223","type":"journal-article","created":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T22:01:44Z","timestamp":1781647304000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":1,"title":["Concordance Between Bedside and Electronic Detection of Intracranial Pressure Crises: Insights From the Brain Tissue Oxygen Monitoring and Management in Severe Traumatic Brain Injury II Trial"],"prefix":"10.1097","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6377-3666","authenticated-orcid":false,"given":"Randall M.","family":"Chesnut","sequence":"first","affiliation":[{"name":"Department of Neurological Surgery, University of Washington, Seattle, WA."},{"name":"Department of Orthopaedic Surgery, University of Washington, Seattle, WA."},{"name":"School of Global Health, University of Washington, Seattle, WA."},{"name":"Harborview Medical Center, University of Washington, Seattle, WA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nancy","family":"Temkin","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Washington, Seattle, WA."},{"name":"Department of Biostatistics, University of Washington, Seattle, WA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason","family":"Barber","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Washington, Seattle, WA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Washington, Seattle, WA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert H.","family":"Bonow","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Washington, Seattle, WA."},{"name":"Harborview Medical Center, University of Washington, Seattle, WA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"On behalf of the Brain Tissue Oxygen Monitoring and Management in Severe Traumatic Brain Injury II (BOOST II) Investigators","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,6,18]]},"reference":[{"key":"R1-20261002","doi-asserted-by":"crossref","first-page":"503","DOI":"10.3171\/jns.1977.47.4.0503","article-title":"Significance of intracranial hypertension in severe head injury.","volume":"47","author":"Miller","year":"1977","journal-title":"J Neurosurg"},{"key":"R2-20261002","doi-asserted-by":"crossref","first-page":"e060188","DOI":"10.1136\/bmjopen-2021-060188","article-title":"Brain oxygen optimization in 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