Evidence map›Paper›PMID 42806262›Full record

ReviewNeurocritical care2026

Intracranial Pressure Estimation Using B4C Device: A Systematic Review on the Validation Studies.

Juliana Caldas, Fernanda Alves, Carla Rynkowski, Davi Solla, Daniel Agustin Godoy, Chiara Robba, Fabio S Taccone, Sérgio Brasil

Abstract readReview
PubMed Publisher
In one paragraph

Review in Neurocritical care, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Juliana CaldasEscola Bahiana de Medicina e Saúde Pública, Av. Dom João VI, 275, Brotas, Salvador, BA, 40290-000, Brazil. caldas.juliana@gmail.com.ORCID http://orcid.org/0000-0001-5793-980X
Fernanda AlvesIntensive Care Unit, Hospital São Rafael, Salvador, BA, Brazil.
Carla RynkowskiEmergency and Trauma Surgery, Medical Faculty, the Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil.
Davi SollaDivision of Neurosurgery, Department of Neurology, University of São Paulo Medical School, São Paulo, Brazil.
Daniel Agustin GodoyMeditech Foundation, Cali, Colombia.
Chiara RobbaAnesthesia and Intensive Care, IRCCS Policlinico San Martino, Genova, Italy.
Fabio S TacconeProfessor of Emergency Medicine, Université Libre de Bruxelles (ULB), Brussels, Belgium.
Sérgio BrasilDivision of Neurosurgery, Department of Neurology, University of São Paulo Medical School, São Paulo, Brazil.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Intracranial hypertension (IH) is a frequent and serious complication of acute brain injury, strongly influencing morbidity and mortality. While invasive intracranial pressure (ICP) monitoring is standard, it has limitations. Intracranial compliance (ICC) offers additional insight into the brain's ability to handle changes in volume. Noninvasive ICP waveform analysis, such as the peak 2 (P2)/peak 1 (P1) ratio and time to peak (TTP), shows promise in evaluating ICC and detecting IH. The brain4care (B4C) system provides continuous, noninvasive monitoring for neurocritical care. We systematically reviewed studies comparing B4C with invasive ICP monitoring, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. MEDLINE, Embase, and the Scientific Electronic Library Online were searched for clinical studies from 2016 to May 2025 reporting quantitative B4C parameters in patients undergoing invasive ICP monitoring. Two reviewers evaluated studies, extracted data, and assessed quality using the Newcastle-Ottawa Scale. Sixteen studies involving 826 patients with acute brain injury were reviewed. The P2/P1 ratio, frequently assessed, showed high sensitivity (26.8-100%) and variable specificity (45.5-96.5%) for IH, with moderate to good accuracy (area under the curve [AUC] 0.71-0.83). TTP was less consistent, although a 0.3 threshold gave 92% specificity in the largest study. All studies demonstrated qualitative morphological concordance between B4C-derived and invasive ICP waveforms. The overall methodological quality was moderate, with frequent limitations related to comparability, confounder adjustment, and follow-up. B4C noninvasive monitoring provides reliable reflections of ICC and shows strong correlation with IH, consistently aligning with invasive ICP waveform patterns. This approach is well tolerated as an adjunct for dynamic, physiology-driven neurocritical care. Further prospective, multicenter studies are necessary to clearly define its clinical utility and support safe integration into standard practice.

Indexed as

Acute brain injuryCerebrospinal complianceIntracranial complianceIntracranial elastanceIntracranial pressureNeurocritical careNoninvasive neuromonitoringSkull deformationSkull extensometer

Identifiers

PMID42806262

What Socratic holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.