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

Pierre Bouzat, Gilles Francony, Philippe Declety, Céline Genty, Affif Kaddour, Pierre Bessou, Julien Brun, Claude Jacquot, Stephan Chabardes, Jean Luc Bosson, Jean François Payen

Research output: Contribution to journalArticle

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 languageEnglish (US)
Pages (from-to)1603-1609
Number of pages7
JournalNeurosurgery
Volume68
Issue number6
DOIs
StatePublished - Jun 2011
Externally publishedYes

Fingerprint

Patient Admission
Coma
Cerebrovascular Circulation
Databases
Glasgow Coma Scale
Blood Flow Velocity
Tomography
Wounds and Injuries
Area Under Curve
Traumatic Brain Injury
Middle Cerebral Artery
Brain
ROC Curve
Observational Studies
Cohort Studies

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

Bouzat, P., Francony, G., Declety, P., Genty, C., Kaddour, A., Bessou, P., ... Payen, J. F. (2011). Transcranial doppler to screen on admission patients with mild to moderate traumatic brain injury. Neurosurgery, 68(6), 1603-1609. https://doi.org/10.1227/NEU.0b013e31820cd43e

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 journalArticle

Bouzat, P, Francony, G, Declety, P, Genty, C, Kaddour, A, Bessou, P, Brun, J, Jacquot, C, Chabardes, S, Bosson, JL & Payen, JF 2011, 'Transcranial doppler to screen on admission patients with mild to moderate traumatic brain injury', Neurosurgery, vol. 68, no. 6, pp. 1603-1609. https://doi.org/10.1227/NEU.0b013e31820cd43e
Bouzat, Pierre ; Francony, Gilles ; Declety, Philippe ; Genty, Céline ; Kaddour, Affif ; Bessou, Pierre ; Brun, Julien ; Jacquot, Claude ; Chabardes, Stephan ; Bosson, Jean Luc ; Payen, Jean François. / Transcranial doppler to screen on admission patients with mild to moderate traumatic brain injury. In: Neurosurgery. 2011 ; Vol. 68, No. 6. pp. 1603-1609.
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AU - Declety, Philippe

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AU - Kaddour, Affif

AU - Bessou, Pierre

AU - Brun, Julien

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AU - Chabardes, Stephan

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AU - Payen, Jean François

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KW - Minor head injury

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KW - Neuroworsening

KW - Outcome

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