Skip to Main content Skip to Navigation
Journal articles

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

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.
Document type :
Journal articles
Complete list of metadatas

Cited literature [39 references]  Display  Hide  Download

https://www.hal.inserm.fr/inserm-00658920
Contributor : Michel Dojat <>
Submitted on : Wednesday, January 11, 2012 - 5:07:57 PM
Last modification on : Thursday, August 27, 2020 - 11:36:03 AM
Long-term archiving on: : Tuesday, December 13, 2016 - 9:53:17 PM

File

 Restricted access
To satisfy the distribution rights of the publisher, the document is embargoed until : jamais

Please log in to resquest access to the document

Identifiers

Collections

U836 | UGA

Citation

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, Lippincott, Williams & Wilkins, 2011, 68 (6), pp.1603-9; discussion 1609-10. ⟨10.1227/NEU.0b013e31820cd43e⟩. ⟨inserm-00658920⟩

Share

Metrics

Record views

373