Poor Accuracy of Manually Derived Head Computed Tomography Parameters in Predicting Intracranial Hypertension After Nontraumatic Intracranial Hemorrhage
Frontera, Jennifer A; Fang, Taolin; Grayson, Kammi; Lalchan, Rebecca; Dickstein, Leah; Hussain, M Shazam; Kahn, D Ethan; Lord, Aaron S; Mazzuchin, Daniel; Melmed, Kara R; Rutledge, Caleb; Zhou, Ting; Lewis, Ariane
BACKGROUND:The utility of head computed tomography (CT) in predicting elevated intracranial pressure (ICP) is known to be limited in traumatic brain injury; however, few data exist in patients with spontaneous intracranial hemorrhage. METHODS:We conducted a retrospective review of prospectively collected data in patients with nontraumatic intracranial hemorrhage (subarachnoid hemorrhage [SAH] or intraparenchymal hemorrhage [IPH]) who underwent external ventricular drain (EVD) placement. Head CT scans performed immediately prior to EVD placement were quantitatively reviewed for features suggestive of elevated ICP, including temporal horn diameter, bicaudate index, basal cistern effacement, midline shift, and global cerebral edema. The modified Fisher score (mFS), intraventricular hemorrhage score, and IPH volume were also measured, as applicable. We calculated the accuracy, positive predictive value (PPV), and negative predictive value (NPV) of these radiographic features for the coprimary outcomes of elevated ICP (> 20 mm Hg) at the time of EVD placement and at any time during the hospital stay. Multivariable backward stepwise logistic regression analysis was performed to identify significant radiographic factors associated with elevated ICP. RESULTS:Of 608 patients with intracranial hemorrhages enrolled during the study time frame, 243 (40%) received an EVD and 165 (n = 107 SAH, n = 58 IPH) had a preplacement head CT scan available for rating. Elevated opening pressure and elevated ICP during hospitalization were recorded in 48 of 152 (29%) and 103 of 165 (62%), respectively. The presence of ≥ 1 radiographic feature had only 32% accuracy for identifying elevated opening pressure (PPV 30%, NPV 58%, area under the curve [AUC] 0.537, 95% asymptotic confidence interval [CI] 0.436-0.637, P = 0.466) and 59% accuracy for predicting elevated ICP during hospitalization (PPV 63%, NPV 40%, AUC 0.514, 95% asymptotic CI 0.391-0.638, P = 0.820). There was no significant association between the number of radiographic features and ICP elevation. Head CT scans without any features suggestive of elevated ICP occurred in 25 of 165 (15%) patients. However, 10 of 25 (40%) of these patients had elevated opening pressure, and 15 of 25 (60%) had elevated ICP during their hospital stay. In multivariable models, mFS (adjusted odds ratio [aOR] 1.36, 95% CI 1.10-1.68) and global cerebral edema (aOR 2.93, 95% CI 1.27-6.75) were significantly associated with elevated ICP; however, their accuracies were only 69% and 60%, respectively. All other individual radiographic features had accuracies between 38 and 58% for identifying intracranial hypertension. CONCLUSIONS:More than 50% of patients with spontaneous intracranial hemorrhage without radiographic features suggestive of elevated ICP actually had ICP > 20 mm Hg during EVD placement or their hospital stay. Morphological head CT findings were only 32% and 59% accurate in identifying elevated opening pressure and ICP elevation during hospitalization, respectively.
PMID: 36577900
ISSN: 1556-0961
CID: 5409662
Validation of the Collaborative Outcomes study on Health and Functioning during Infection Times (COH-FIT) questionnaire for adults
Solmi, Marco; Thompson, Trevor; Estradé, Andrés; Agorastos, Agorastos; Radua, Joaquim; Cortese, Samuele; Dragioti, Elena; Leisch, Friedrich; Vancampfort, Davy; Thygesen, Lau Caspar; Aschauer, Harald; Schlögelhofer, Monika; Aschauer, Elena; Schneeberger, Andres; Huber, Christian G; Hasler, Gregor; Conus, Philippe; Do Cuénod, Kim Q; von Känel, Roland; Arrondo, Gonzalo; Fusar-Poli, Paolo; Gorwood, Philip; Llorca, Pierre-Michel; Krebs, Marie-Odile; Scanferla, Elisabetta; Kishimoto, Taishiro; Rabbani, Golam; Skonieczna-Żydecka, Karolina; Brambilla, Paolo; Favaro, Angela; Takamiya, Akihiro; Zoccante, Leonardo; Colizzi, Marco; Bourgin, Julie; Kamiński, Karol; Moghadasin, Maryam; Seedat, Soraya; Matthews, Evan; Wells, John; Vassilopoulou, Emilia; Gadelha, Ary; Su, Kuan-Pin; Kwon, Jun Soo; Kim, Minah; Lee, Tae Young; Papsuev, Oleg; Manková, Denisa; Boscutti, Andrea; Gerunda, Cristiano; Saccon, Diego; Righi, Elena; Monaco, Francesco; Croatto, Giovanni; Cereda, Guido; Demurtas, Jacopo; Brondino, Natascia; Veronese, Nicola; Enrico, Paolo; Politi, Pierluigi; Ciappolino, Valentina; Pfennig, Andrea; Bechdolf, Andreas; Meyer-Lindenberg, Andreas; Kahl, Kai G; Domschke, Katharina; Bauer, Michael; Koutsouleris, Nikolaos; Winter, Sibylle; Borgwardt, Stefan; Bitter, Istvan; Balazs, Judit; Czobor, Pál; Unoka, Zsolt; Mavridis, Dimitris; Tsamakis, Konstantinos; Bozikas, Vasilios P; Tunvirachaisakul, Chavit; Maes, Michael; Rungnirundorn, Teerayuth; Supasitthumrong, Thitiporn; Haque, Ariful; Brunoni, Andre R; Costardi, Carlos Gustavo; Schuch, Felipe Barreto; Polanczyk, Guilherme; Luiz, Jhoanne Merlyn; Fonseca, Lais; Aparicio, Luana V; Valvassori, Samira S; Nordentoft, Merete; Vendsborg, Per; Hoffmann, Sofie Have; Sehli, Jihed; Sartorius, Norman; Heuss, Sabina; Guinart, Daniel; Hamilton, Jane; Kane, John; Rubio, Jose; Sand, Michael; Koyanagi, Ai; Solanes, Aleix; Andreu-Bernabeu, Alvaro; Cáceres, Antonia San José; Arango, Celso; Díaz-Caneja, Covadonga M; Hidalgo-Mazzei, Diego; Vieta, Eduard; Gonzalez-Peñas, Javier; Fortea, Lydia; Parellada, Mara; Fullana, Miquel A; Verdolini, Norma; Andrlíková, Eva; Janků, Karolina; Millan, Mark John; Honciuc, Mihaela; Moniuszko-Malinowska, Anna; Łoniewski, Igor; Samochowiec, Jerzy; Kiszkiel, Łukasz; Marlicz, Maria; Sowa, Paweł; Marlicz, Wojciech; Spies, Georgina; Stubbs, Brendon; Firth, Joseph; Sullivan, Sarah; Darcin, Asli Enez; Aksu, Hatice; Dilbaz, Nesrin; Noyan, Onur; Kitazawa, Momoko; Kurokawa, Shunya; Tazawa, Yuki; Anselmi, Alejandro; Cracco, Cecilia; Machado, Ana Inés; Estrade, Natalia; De Leo, Diego; Curtis, Jackie; Berk, Michael; Ward, Philip; Teasdale, Scott; Rosenbaum, Simon; Marx, Wolfgang; Horodnic, Adrian Vasile; Oprea, Liviu; Alexinschi, Ovidiu; Ifteni, Petru; Turliuc, Serban; Ciuhodaru, Tudor; Bolos, Alexandra; Matei, Valentin; Nieman, Dorien H; Sommer, Iris; van Os, Jim; van Amelsvoort, Therese; Sun, Ching-Fang; Guu, Ta-Wei; Jiao, Can; Zhang, Jieting; Fan, Jialin; Zou, Liye; Yu, Xin; Chi, Xinli; de Timary, Philippe; van Winkel, Ruud; Ng, Bernardo; Pena, Edilberto; Arellano, Ramon; Roman, Raquel; Sanchez, Thelma; Movina, Larisa; Morgado, Pedro; Brissos, Sofia; Aizberg, Oleg; Mosina, Anna; Krinitski, Damir; Mugisha, James; Sadeghi-Bahmani, Dena; Sheybani, Farshad; Sadeghi, Masoud; Hadi, Samira; Brand, Serge; Errazuriz, Antonia; Crossley, Nicolas; Ristic, Dragana Ignjatovic; López-Jaramillo, Carlos; Efthymiou, Dimitris; Kuttichira, Praveenlal; Kallivayalil, Roy Abraham; Javed, Afzal; Afridi, Muhammad Iqbal; James, Bawo; Seb-Akahomen, Omonefe Joy; Fiedorowicz, Jess; Carvalho, Andre F; Daskalakis, Jeff; Yatham, Lakshmi N; Yang, Lin; Okasha, Tarek; Dahdouh, Aïcha; Gerdle, Björn; Tiihonen, Jari; Shin, Jae Il; Lee, Jinhee; Mhalla, Ahmed; Gaha, Lotfi; Brahim, Takoua; Altynbekov, Kuanysh; Negay, Nikolay; Nurmagambetova, Saltanat; Jamei, Yasser Abu; Weiser, Mark; Correll, Christoph U
BACKGROUND:The Collaborative Outcome study on Health and Functioning during Infection Times (COH-FIT; www.coh-fit.com) is an anonymous and global online survey measuring health and functioning during the COVID-19 pandemic. The aim of this study was to test concurrently the validity of COH-FIT items and the internal validity of the co-primary outcome, a composite psychopathology "P-score". METHODS:The COH-FIT survey has been translated into 30 languages (two blind forward-translations, consensus, one independent English back-translation, final harmonization). To measure mental health, 1-4 items ("COH-FIT items") were extracted from validated questionnaires (e.g. Patient Health Questionnaire 9). COH-FIT items measured anxiety, depressive, post-traumatic, obsessive-compulsive, bipolar and psychotic symptoms, as well as stress, sleep and concentration. COH-FIT Items which correlated r ≥ 0.5 with validated companion questionnaires, were initially retained. A P-score factor structure was then identified from these items using exploratory factor analysis (EFA) and confirmatory factor analyses (CFA) on data split into training and validation sets. Consistency of results across languages, gender and age was assessed. RESULTS:From >150,000 adult responses by May 6th, 2022, a subset of 22,456 completed both COH-FIT items and validated questionnaires. Concurrent validity was consistently demonstrated across different languages for COH-FIT items. CFA confirmed EFA results of five first-order factors (anxiety, depression, post-traumatic, psychotic, psychophysiologic symptoms) and revealed a single second-order factor P-score, with high internal reliability (ω = 0.95). Factor structure was consistent across age and sex. CONCLUSIONS:COH-FIT is a valid instrument to globally measure mental health during infection times. The P-score is a valid measure of multidimensional mental health.
PMCID:9794522
PMID: 36586617
ISSN: 1573-2517
CID: 5442082