Transcranial Doppler to Screen on Admission Patients With Mild to Moderate Traumatic Brain Injury

• Published in: Neurosurgery Vol. 68; no. 6; pp. 1603 - 1610
• Main Authors: Bouzat, Pierre, Francony, Gilles, Declety, Philippe, Genty, Céline, Kaddour, Affif, Bessou, Pierre, Brun, Julien, Jacquot, Claude, Chabardes, Stephan, Bosson, Jean-Luc, Payen, Jean-François
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Oxford University Press 01.06.2011; Lippincott Williams & Wilkins; Wolters Kluwer Health, Inc; Lippincott, Williams & Wilkins
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Area Under Curve; Biological and medical sciences; Brain Injuries; Brain Injuries - diagnostic imaging; Cerebrovascular Circulation; Cerebrovascular Circulation - physiology; Cohort Studies; Coma; Disease Progression; Female; Flow velocity; Glasgow Coma Scale; Humans; Life Sciences; Male; Medical sciences; Middle Aged; Neurons and Cognition; Neurosurgery; Prospective Studies; Risk Factors; ROC Curve; Sensitivity and Specificity; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Traumatic brain injury; Ultrasonography, Doppler, Transcranial; Young Adult; Mild traumatic brain injury; Outcome; Neuroworsening; Minor head injury; Computed tomographic scan; Moderate head injury; Transcranial Doppler; Doppler ultrasound study; Human; Nervous system diseases; Prognosis; Craniocerebral; Medical screening; Surgery; Computerized axial tomography; Head trauma
• ISSN: 0148-396X; 1524-4040
• DOI: 10.1227/NEU.0b013e31820cd43e

Abstract BACKGROUND: Detecting patients at risk for secondary neurological deterioration (SND) after mild to moderate traumatic brain injury is challenging. OBJECTIVE: To assess the diagnostic accuracy of transcranial Doppler (TCD) on admission in screening these patients. METHODS: This prospective, observational cohort study enrolled 98 traumatic brain injury patients with an initial Glasgow Coma Scale score of 9 to 15 whose initial computed tomography (CT) scan showed either absent or mild lesions according to the Trauma Coma Data Bank (TCDB) classification, ie, TCDB I and TCDB II, respectively. TCD measurements of the 2 middle cerebral arteries were obtained on admission under stable conditions in all patients. Neurological outcome was reassessed on day 7. RESULTS: Of the 98 patients, 21 showed SND, ie, a decrease of ≥ 2 points from the initial Glasgow Coma Scale or requiring any treatment for neurological deterioration. Diastolic cerebral blood flow velocities and pulsatility index measurements were different between patients with SND and patients with no SND. Using receiver-operating characteristic analysis, we found the best threshold limits to be 25 cm/s (sensitivity, 92%; specificity, 76%; area under curve, 0.93) for diastolic cerebral blood flow velocity and 1.25 (sensitivity, 90%; specificity, 91%; area under curve, 0.95) for pulsatility index. According to a recursive-partitioning analysis, TCDB classification and TCD measurements were the most discriminative among variables to detect patients at risk for SND. CONCLUSION: In patients with no severe brain lesions on CT after mild to moderate traumatic brain injury, TCD on admission, in complement with brain CT scan, could accurately screen patients at risk for SND.