Pressure Points: A Scoping Review of Intracranial Pressure and Mean Arterial Pressure Measurement and Reporting Practices in Neurocritical Care.

Abstract

Cerebral perfusion pressure (CPP) is a cornerstone of neurocritical care, but the literature shows substantial heterogeneity in how its components-intracranial pressure (ICP) and mean arterial pressure (MAP)-are reported. We conducted a scoping review following the Joanna Briggs Institute methodology and PRISMA-ScR to map this variability. Structured searches in PubMed and Scopus (January 1997 to May 2026) identified 350 eligible original clinical studies. For each study, we extracted whether the ICP measurement method, ICP device, ICP zero reference, MAP measurement method, and arterial line zero reference were reported. Reporting completeness was analyzed overall and stratified by guideline era and primary diagnosis, using the χ2 tests, odds ratios with 95% CI, and the Cochran-Armitage test for trend. The ICP measurement method was reported in 84.0% of studies, and the ICP zero reference in 14.6%; the MAP method in 66.9%, and the arterial line zero reference in 28.6%. Only 6.6% of studies reported all 5 domains. After publication of the Brain Trauma Foundation fourth Edition, reporting improved across most domains-ICP method (79.0% vs. 96.1%, P<0.001) and arterial line zero reference (20.2% vs. 49.0%, P<0.001)-and the composite reporting score rose from 2.37 to 3.06 (P<0.001). ICP zero-reference reporting was similar between eras (16.5% vs. 9.8%, P=0.105) while showing a significant declining trend across the study period (Cochran-Armitage Z=-2.52, P=0.012). Traumatic brain injury and hemorrhagic conditions had the lowest ICP zero reference reporting (8.8% and 9.3%; OR=0.35 for TBI vs. non-TBI, 95% CI: 0.19-0.65). Improvements in reporting have not reached the level needed to determine whether CPP values are comparable across studies. We propose an 11-item Minimum Reporting Set for CPP-related studies.