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.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 1603-1609 |
| Number of pages | 7 |
| Journal | Neurosurgery |
| Volume | 68 |
| Issue number | 6 |
| DOIs | |
| State | Published - Jun 2011 |
| Externally published | Yes |
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Keywords
- Computed tomographic scan
- Mild traumatic brain injury
- Minor head injury
- Moderate head injury
- Neuroworsening
- Outcome
- Transcranial Doppler
ASJC Scopus subject areas
- Clinical Neurology
- Surgery
Cite this
Transcranial doppler to screen on admission patients with mild to moderate traumatic brain injury. / Bouzat, Pierre; Francony, Gilles; Declety, Philippe; Genty, Céline; Kaddour, Affif; Bessou, Pierre; Brun, Julien; Jacquot, Claude; Chabardes, Stephan; Bosson, Jean Luc; Payen, Jean François.
In: Neurosurgery, Vol. 68, No. 6, 06.2011, p. 1603-1609.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Transcranial doppler to screen on admission patients with mild to moderate traumatic brain injury
AU - Bouzat, Pierre
AU - Francony, Gilles
AU - Declety, Philippe
AU - Genty, Céline
AU - Kaddour, Affif
AU - Bessou, Pierre
AU - Brun, Julien
AU - Jacquot, Claude
AU - Chabardes, Stephan
AU - Bosson, Jean Luc
AU - Payen, Jean François
PY - 2011/6
Y1 - 2011/6
N2 - 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.
AB - 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.
KW - Computed tomographic scan
KW - Mild traumatic brain injury
KW - Minor head injury
KW - Moderate head injury
KW - Neuroworsening
KW - Outcome
KW - Transcranial Doppler
UR - http://www.scopus.com/inward/record.url?scp=79955925144&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=79955925144&partnerID=8YFLogxK
U2 - 10.1227/NEU.0b013e31820cd43e
DO - 10.1227/NEU.0b013e31820cd43e
M3 - Article
C2 - 21311381
AN - SCOPUS:79955925144
VL - 68
SP - 1603
EP - 1609
JO - Neurosurgery
JF - Neurosurgery
SN - 0148-396X
IS - 6
ER -