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Transcranial Doppler to Predict Neurologic Outcome after Mild to Moderate Traumatic Brain Injury.

Abstract：

BACKGROUND:To assess the performance of transcranial Doppler (TCD) in predicting neurologic worsening after mild to moderate traumatic brain injury. METHODS:The authors conducted a prospective observational study across 17 sites. TCD was performed upon admission in 356 patients (Glasgow Coma Score [GCS], 9 to 15) with mild lesions on cerebral computed tomography scan. Normal TCD was defined as a pulsatility index of less than 1.25 and diastolic blood flow velocity higher than 25 cm/s in the two middle cerebral arteries. The primary endpoint was secondary neurologic deterioration on day 7. RESULTS:Twenty patients (6%) developed secondary neurologic deterioration within the first posttraumatic week. TCD thresholds had 80% sensitivity (95% CI, 56 to 94%) and 79% specificity (95% CI, 74 to 83%) to predict neurologic worsening. The negative predictive values and positive predictive values of TCD were 98% (95% CI, 96 to 100%) and 18% (95% CI, 11to 28%), respectively. In patients with minor traumatic brain injury (GCS, 14 to 15), the sensitivity and specificity of TCD were 91% (95% CI, 59 to 100%) and 80% (95% CI, 75 to 85%), respectively. The area under the receiver operating characteristic curve of a multivariate predictive model including age and GCS was significantly improved with the adjunction of TCD. Patients with abnormal TCD on admission (n = 86 patients) showed a more altered score for the disability rating scale on day 28 compared to those with normal TCD (n = 257 patients). CONCLUSIONS:TCD measurements upon admission may provide additional information about neurologic outcome after mild to moderate traumatic brain injury. This technique could be useful for in-hospital triage in this context. (Anesthesiology 2016; 125:346-54).

journal_name

Anesthesiology

journal_title

Anesthesiology

authors

Bouzat P,Almeras L,Manhes P,Sanders L,Levrat A,David JS,Cinotti R,Chabanne R,Gloaguen A,Bobbia X,Thoret S,Oujamaa L,Bosson JL,Payen JF,Asehnoune K,Pes P,Lefrant JY,Mirek S,Albasini F,Scrimgeour C,Thouret JM,Char

doi

10.1097/ALN.0000000000001165

subject

Has Abstract

pub_date

2016-08-01 00:00:00

pages

346-54

issue

eissn

0003-3022

issn

1528-1175

journal_volume

125

pub_type

杂志文章,多中心研究

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Transcranial Doppler to Predict Neurologic Outcome after Mild to Moderate Traumatic Brain Injury.