Studying Trends of Auto-Regulation in Severe Head Injury in Paediatrics (STARSHIP): Protocol to Study Cerebral Autoregulation in a Prospective Multicentre Observational Research Database Study

Overview

Journal BMJ Open

Specialty General Medicine

Date 2023 Mar 10

PMID 36898758

Authors

Shruti Agrawal

Michal M Placek

Deborah White

Esther Daubney

Manuel Cabeleira

Peter Smielewski

Marek Czosnyka

Adam Young

Suzanna Watson

Anna Maw

Peter John Hutchinson

Affiliations

Soon will be listed here.

Abstract

Introduction: Studying cerebral autoregulation, particularly PRx (Pressure Reactivity Index), is commonly employed in adult traumatic brain injury (TBI) and gives real-time information about intracranial pathophysiology, which can help in patient management. Experience in paediatric TBI (PTBI) is limited to single-centre studies despite disproportionately higher incidence of morbidity and mortality in PTBI than in adult TBI.

Project: We describe the protocol to study cerebral autoregulation using PRx in PTBI. The project called Studying Trends of Auto-Regulation in Severe Head Injury in Paediatrics is a multicentre prospective ethics approved research database study from 10 centres across the UK. Recruitment started in July 2018 with financial support from local/national charities (Action Medical Research for Children, UK).

Methods And Analysis: The first phase of the project is powered to detect optimal thresholds of PRx associated with favourable outcome in PTBI by recruiting 135 patients (initial target of 3 years which has changed to 5 years due to delays related to COVID-19 pandemic) from 10 centres in the UK with outcome follow-up to 1-year postictus. The secondary objectives are to characterise patterns of optimal cerebral perfusion pressure in PTBI and compare the fluctuations in these measured parameters with outcome. The goal is to create a comprehensive research database of a basic set of high-resolution (full waveforms resolution) neuromonitoring data in PTBI for scientific use.

Ethics And Dissemination: Favourable ethical approval has been provided by Health Research Authority, Southwest-Central Bristol Research Ethics Committee (Ref: 18/SW/0053). Results will be disseminated via publications in peer-reviewed medical journals and presentations at national and international conferences.

Trial Registration Number: NCT05688462.

Citing Articles

Status of cerebrovascular autoregulation relates to outcome in severe paediatric head injury: STARSHIP, a prospective multicentre validation study.

Agrawal S, Smith C, Bogli S, Placek M, Cabeleira M, White D EClinicalMedicine. 2025; 81:103077.

PMID: 39996125 PMC: 11848105. DOI: 10.1016/j.eclinm.2025.103077.

Intracranial Pressure and Its Related Parameters in the Management of Severe Pediatric Traumatic Brain Injury.

Wang V Adv Neurobiol. 2024; 42:3-19.

PMID: 39432035 DOI: 10.1007/978-3-031-69832-3_1.

Advanced neuromonitoring powered by ICM+ and its place in the Brand New AI World, reflections at the 20th anniversary boundary.

Smielewski P, Beqiri E, Mataczynski C, Placek M, Kazimierska A, Hutchinson P Brain Spine. 2024; 4:102835.

PMID: 39071453 PMC: 11278591. DOI: 10.1016/j.bas.2024.102835.

How to Define and Meet Blood Pressure Targets After Traumatic Brain Injury: A Narrative Review.

Kartal A, Robba C, Helmy A, Wolf S, Aries M Neurocrit Care. 2024; 41(2):369-385.

PMID: 38982005 PMC: 11377672. DOI: 10.1007/s12028-024-02048-5.

Cerebral autoregulation in pediatric and neonatal intensive care: A scoping review.

Fedriga M, Martini S, Iodice F, Sortica da Costa C, Pezzato S, Moscatelli A J Cereb Blood Flow Metab. 2024; 44(11):1208-1226.

PMID: 38867574 PMC: 11542144. DOI: 10.1177/0271678X241261944.

References

Lang E, Chesnut R . Intracranial pressure and cerebral perfusion pressure in severe head injury. New Horiz. 1995; 3(3):400-9. View

Bayreuther J, Wagener S, Woodford M, Edwards A, Lecky F, Bouamra O . Paediatric trauma: injury pattern and mortality in the UK. Arch Dis Child Educ Pract Ed. 2009; 94(2):37-41. DOI: 10.1136/adc.2007.132787. View

Jaeger M, Lang E . Cerebrovascular pressure reactivity and cerebral oxygen regulation after severe head injury. Neurocrit Care. 2013; 19(1):69-73. DOI: 10.1007/s12028-013-9857-7. View

Young A, Donnelly J, Czosnyka M, Jalloh I, Liu X, Aries M . Continuous Multimodality Monitoring in Children after Traumatic Brain Injury-Preliminary Experience. PLoS One. 2016; 11(3):e0148817. PMC: 4792535. DOI: 10.1371/journal.pone.0148817. View

Fombonne E . Diagnostic assessment in a sample of autistic and developmentally impaired adolescents. J Autism Dev Disord. 1992; 22(4):563-81. DOI: 10.1007/BF01046328. View

Lewis P, Czosnyka M, Carter B, Rosenfeld J, Paul E, Singhal N . Cerebrovascular Pressure Reactivity in Children With Traumatic Brain Injury. Pediatr Crit Care Med. 2015; 16(8):739-49. DOI: 10.1097/PCC.0000000000000471. View

Kochanek P, Tasker R, Carney N, Totten A, Adelson P, Selden N . Guidelines for the Management of Pediatric Severe Traumatic Brain Injury, Third Edition: Update of the Brain Trauma Foundation Guidelines. Pediatr Crit Care Med. 2019; 20(3S Suppl 1):S1-S82. DOI: 10.1097/PCC.0000000000001735. View

Dewan M, Mummareddy N, Wellons 3rd J, Bonfield C . Epidemiology of Global Pediatric Traumatic Brain Injury: Qualitative Review. World Neurosurg. 2016; 91:497-509.e1. DOI: 10.1016/j.wneu.2016.03.045. View

Hirvikoski T, Lajic S, Jokinen J, Renhorn E, Trillingsgaard A, Kadesjo B . Using the five to fifteen-collateral informant questionnaire for retrospective assessment of childhood symptoms in adults with and without autism or ADHD. Eur Child Adolesc Psychiatry. 2020; 30(9):1367-1381. PMC: 8440248. DOI: 10.1007/s00787-020-01600-w. View

10.

le Roux P, Menon D, Citerio G, Vespa P, Bader M, Brophy G . The International Multidisciplinary Consensus Conference on Multimodality Monitoring in Neurocritical Care: evidentiary tables: a statement for healthcare professionals from the Neurocritical Care Society and the European Society of Intensive Care.... Neurocrit Care. 2015; 21 Suppl 2:S297-361. PMC: 10596300. DOI: 10.1007/s12028-014-0081-x. View

11.

Lugnegard T, Bejerot S . Retrospective parental assessment of childhood neurodevelopmental problems: the use of the Five to Fifteen questionnaire in adults. BJPsych Open. 2019; 5(3):e42. PMC: 6537455. DOI: 10.1192/bjo.2019.30. View

12.

Czosnyka M, Smielewski P, Kirkpatrick P, Laing R, Menon D, Pickard J . Continuous assessment of the cerebral vasomotor reactivity in head injury. Neurosurgery. 1997; 41(1):11-7; discussion 17-9. DOI: 10.1097/00006123-199707000-00005. View

13.

Lord C, Rutter M, Le Couteur A . Autism Diagnostic Interview-Revised: a revised version of a diagnostic interview for caregivers of individuals with possible pervasive developmental disorders. J Autism Dev Disord. 1994; 24(5):659-85. DOI: 10.1007/BF02172145. View

14.

Sorrentino E, Diedler J, Kasprowicz M, Budohoski K, Haubrich C, Smielewski P . Critical thresholds for cerebrovascular reactivity after traumatic brain injury. Neurocrit Care. 2011; 16(2):258-66. DOI: 10.1007/s12028-011-9630-8. View

15.

Steiner L, Czosnyka M, Piechnik S, Smielewski P, Chatfield D, Menon D . Continuous monitoring of cerebrovascular pressure reactivity allows determination of optimal cerebral perfusion pressure in patients with traumatic brain injury. Crit Care Med. 2002; 30(4):733-8. DOI: 10.1097/00003246-200204000-00002. View

16.

Paulson O, Strandgaard S, Edvinsson L . Cerebral autoregulation. Cerebrovasc Brain Metab Rev. 1990; 2(2):161-92. View

17.

Brady K, Shaffner D, Lee J, Easley R, Smielewski P, Czosnyka M . Continuous monitoring of cerebrovascular pressure reactivity after traumatic brain injury in children. Pediatrics. 2009; 124(6):e1205-12. DOI: 10.1542/peds.2009-0550. View

18.

Aries M, Czosnyka M, Budohoski K, Steiner L, Lavinio A, Kolias A . Continuous determination of optimal cerebral perfusion pressure in traumatic brain injury. Crit Care Med. 2012; 40(8):2456-63. DOI: 10.1097/CCM.0b013e3182514eb6. View

19.

Johnson U, Lewen A, Ronne-Engstrom E, Howells T, Enblad P . Should the neurointensive care management of traumatic brain injury patients be individualized according to autoregulation status and injury subtype?. Neurocrit Care. 2014; 21(2):259-65. DOI: 10.1007/s12028-014-9954-2. View