• Pierre Bouzat, Gilles Francony, Philippe Declety, Céline Genty, Affif Kaddour, Pierre Bessou, Julien Brun, Claude Jacquot, Stephan Chabardes, Jean-Luc Bosson, and Jean-François Payen.
• Department of Anesthesia and Critical Care, Albert Michallon Hospital, Grenoble, France.
• Neurosurgery. 2011 Jun 1;68(6):1603-9; discussion 1609-10.

BackgroundDetecting patients at risk for secondary neurological deterioration (SND) after mild to moderate traumatic brain injury is challenging.ObjectiveTo assess the diagnostic accuracy of transcranial Doppler (TCD) on admission in screening these patients.MethodsThis 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.ResultsOf 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.ConclusionIn 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.Copyright © 2011 by the Congress of Neurological Surgeons

23 keywords...

hide…