Transcranial Doppler to screen on admission patients with mild to moderate traumatic brain injury. - Inserm - Institut national de la santé et de la recherche médicale Accéder directement au contenu
Article Dans Une Revue Neurosurgery Année : 2011

Transcranial Doppler to screen on admission patients with mild to moderate traumatic brain injury.

Résumé

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.
Fichier sous embargo
Fichier sous embargo
Date de visibilité indéterminée
Loading...

Dates et versions

inserm-00658920 , version 1 (11-01-2012)

Identifiants

Citer

Pierre Bouzat, Gilles Francony, Philippe Declety, Céline Genty, Affif Kaddour, et al.. Transcranial Doppler to screen on admission patients with mild to moderate traumatic brain injury.. Neurosurgery, 2011, 68 (6), pp.1603-9; discussion 1609-10. ⟨10.1227/NEU.0b013e31820cd43e⟩. ⟨inserm-00658920⟩

Collections

INSERM UGA U836
109 Consultations
2 Téléchargements

Altmetric

Partager

Gmail Facebook X LinkedIn More