Forecasting ICP Elevation Based on Prescient Changes of Intracranial Pressure Waveform Morphology

Interventions of intracranial pressure (ICP) elevation in neurocritical care is currently delivered only after healthcare professionals notice sustained and significant mean ICP elevation. This paper uses the morphological clustering and analysis of ICP (MOCAIP) algorithm to derive 24 metrics characterizing morphology of ICP pulses and test the hypothesis that preintracranial hypertension (Pre-IH) segments of ICP can be differentiated, using these morphological metrics, from control segments that were not associated with any ICP elevation or at least 1 h prior to ICP elevation. Furthermore, we investigate whether a global optimization algorithm could effectively find the optimal subset of these morphological metrics to achieve better classification performance as compared to using full set of MOCAIP metrics. The results showed that Pre-IH segments, using the optimal subset of metrics found by the differential evolution algorithm, can be differentiated from control segments at a specificity of 99% and sensitivity of 37% for these Pre-IH segments 5 min prior to the ICP elevation. While the sensitivity decreased to 21% for Pre-IH segments, 20 min prior to ICP elevation, the high specificity of 99% was retained. The performance using the full set of MOCAIP metrics was shown inferior to results achieved using the optimal subset of metrics. This paper demonstrated that advanced ICP pulse analysis combined with machine learning could potentially leads to the forecasting of ICP elevation so that a proactive ICP management could be realized based on these accurate forecasts.