Transcranial doppler and its impact on the prognosis of traumatic brain injury, Hospital Clínico Viedma, Cochabamba-Bolivia.
DOI:
https://doi.org/10.52428/20756208.v18i45.1037Keywords:
Intracranial pressure, prognosis, traumatic brain injuries, transcranial Doppler ultrasinography.Abstract
Introduction: Traumatic brain injury (TBI) is a major cause of death and disability; Predicting the result is useful in decision making. Transcranial Doppler (TCD) is a diagnostic tool for monitoring cerebral blood flow; could establish a reliable and early forecast. The objective is to evaluate whether the characteristics of the DTC are effective as a prognostic indicator. Material and methods: A prospective study of patients with TBI was carried out. DTC measurements were made upon admission and stay; The pulsatility index was calculated using the formula for systolic and diastolic velocity, divided by the average velocity (SV-RV/MV); intracranial hypertension was considered if the pulsatility index (PI>1.2); The result was evaluated by the GOSE (Glasgow Outcome Scale Extended) score at 3 months (information obtained by telephone), dichotomized: Favorable (4-5) and unfavorable (1-3). Results: 49 patients were included; the unfavorable outcome at 3 months was 63.2%; the analysis of the group with abnormal DTC is 54 times more likely to present an unfavorable outcome (RR: 54; 95 % CI (8.8-32.8); p<0.0005); Sensitivity 78 %; specificity 81%; AUC 0.850, and lower probability of survival at 14 days (p=0.021); Associated independent variables: Glasgow Coma Scale (ECG) close to 3 points RR: 33; 95 % CI (1.31-10.6); hypotension RR: 9.28; 95 % CI (1.49-5.7); craniectomy RR: 1.96; 95 % CI (1.01-4.41); fixed pupils RR: 3.4; 95 % CI (1.15-9.9); Marshall scale in conjunction with the ECG, greater sensitivity and specificity. Conclusion: These data showed a possible effectiveness of DTC as a diagnostic and also prognostic tool in traumatic brain injury.
Keywords: Intracranial pressure, prognosis, traumatic brain injuries, transcranial Doppler ultrasinography.
Downloads
References
Masson F, Thicoipe M, Mokni T. Epidemiology of traumatic coma: a prospective population-based study. Brain Inj 2010; 17:279-93. https://doi.org/10.1080/0269905021000030805
https://doi.org/10.1080/0269905021000030805 DOI: https://doi.org/10.1080/0269905021000030805
Cabrera A, Martínez O, Alejandro Ibarra A, Morales R, Laguna G, Sánchez M. Traumatismo craneoencefálico severo. Medicina Critica y Terapia Intensiva. 2009; 23(2):94-101. https://www.medigraphic.com/pdfs/medcri/ti-2009/ti092g.pdf
Nida F, Ashfaq Shuaib, Talat Saeed Chughtail, et al. The Role of Transcranial Doppler in Traumatic Brain Injury: A Systemic Review and Meta-Analysis. Asian Journal of Neurosurgery. 2019; 14(3): 626-633. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6702999/
https://doi.org/10.4103/ajns.AJNS_42_19 DOI: https://doi.org/10.4103/ajns.AJNS_42_19
Steyerberg EW, Mushkudiani N, Perel P, Butcher I, Lu J, McHugh GS, et al. Predicting outcome after traumatic brain injury: development and international validation of prognostic scores based on admission characteristics. PLoS Med 2008; 5(8):e165; discussion e16. https://doi.org/10.1371/journal.pmed.0050165
https://doi.org/10.1371/journal.pmed.0050165 DOI: https://doi.org/10.1371/journal.pmed.0050165
Bruns J Jr, Hauser WA. The epidemiology of traumatic brain injury: a review. Epilepsia 2003;44 Suppl 10:2-10. https://doi.org/10.1046/j.1528-1157.44.s10.3.x
https://doi.org/10.1046/j.1528-1157.44.s10.3.x DOI: https://doi.org/10.1046/j.1528-1157.44.s10.3.x
Butcher I, Maas AIR, Lu J, Marmarou A, Murray GD, Mushkudiani NA et al. Prognostic value of admission blood pressure in traumatic brain injury: results from the IMPACT study. J Neurotrauma 2007; 24: 294-302. https://doi.org/10.1089/neu.2006.0032
https://doi.org/10.1089/neu.2006.0032 DOI: https://doi.org/10.1089/neu.2006.0032
Tagliaferri F, Compagnone C, Korsic M, Servadei F, Kraus J. A systematic review of brain injury epidemiology in Europe. Acta Neurochir (Wien) 2006; 148: 255-68. https://doi.org/10.1007/s00701-005-0651-y
https://doi.org/10.1007/s00701-005-0651-y DOI: https://doi.org/10.1007/s00701-005-0651-y
Perel P, Arango M. CRASH. Trial Collaborators. Predicting outcome after traumatic brain injury: practical prognostic models based on large cohort of international patients. BMJ 2008; 336: 425-9. https://doi.org/10.1136/bmj.39461.643438.25
https://doi.org/10.1136/bmj.39461.643438.25 DOI: https://doi.org/10.1136/bmj.39461.643438.25
Mushkudiani NA, Engel DC, Steyerberg EW, Butcher I, Lu J, Marmarou A, et al. Prognostic value of demographic characteristics in traumatic brain injury: results from the IMPACT study. J Neurotrauma 2007; 24: 259-69. https://doi.org/10.1089/neu.2006.0028
https://doi.org/10.1089/neu.2006.0028 DOI: https://doi.org/10.1089/neu.2006.0028
Chacón-Lozsán F, et al. Neuromonitorización hemodinámica por ultrasonido en el paciente crítico: ultrasonido transcraneal. Acta Colomb Cuid Intensivo. 2018. https://www.medigraphic.com/cgi-in/new/resumen.cgi?IDARTICULO=111409
https://doi.org/10.1016/j.acci.2018.01.002 DOI: https://doi.org/10.1016/j.acci.2018.01.002
Heather A, Burkman N, Burkman M. Transcranial Doppler series Part I: Understanding neurovascular anatomy. Am J Electroneu-rodiagnostic Technol. 2008; 48: 249-257. https://pubmed.ncbi.nlm.nih.gov/19203078/
https://doi.org/10.1080/1086508X.2008.11079689 DOI: https://doi.org/10.1080/1086508X.2008.11079689
Zweifel C, Czosnyka M, Carrera E, de Riva N, Pickard J, Smie-lewski P. Reliability of the blood flow velocity pulsatility indexfor asseessment of intracranial and cerebral perfussion pressu-res in head-inmured patients. Neurosurgery. 2012; 71: 853-861. https://doi.org/10.1227/neu.0b013e3182675b42
https://doi.org/10.1227/NEU.0b013e3182675b42
Foulkes MA, Eisemberg HM, Jane JA, the Traumatic Coma Data Bank Group. The Traumatic Coma Data Bank: design, methods, and baseline characteristics. J Neurosurg. 1991; 75: 8-36. https://doi.org/10.3171/jns.1983.59.2.0276 DOI: https://doi.org/10.3171/sup.1991.75.1s.00s8
https://doi.org/10.3171/jns.1983.59.2.0276
Murray LS, Teasdale GM, Murray GD, Miller DJ, Pickard JD, Shaw MD. Head injuries in four British neurosurgical centres. Br J Neurosurg. 1999;13 (6): 564-9. https://doi.org/10.1080/02688699943060
https://doi.org/10.1080/02688699943060 DOI: https://doi.org/10.1080/02688699943060
Marshall LF, Becker DP, Bowers SA, Cayard C, Eisenberg H, Gross CR. The National Traumatic Coma Data Bank. Part 1: Design, purpose, goals, and results. J Neurosurg. 1983 Aug;59(2):276-84. https://doi.org/10.3171/jns.1983.59.2.0276
https://doi.org/10.3171/jns.1983.59.2.0276 DOI: https://doi.org/10.3171/jns.1983.59.2.0276
Mosquera CG, Van Duc H, Casares JA, Hernández EH. Caracterización de los pacientes con traumatismo craneoencefálico y lesión axonal traumática. Rev Arch Med Camagüey 2016; 20 (6): 609-18. https://www.redalyc.org/pdf/2111/211148859004.pdf
Cooper DJ, Rosenfeld JV, Murray L, Arabi YM, Davies AR, D'Urso P, et al. Decompressive Craniectomy in Diffuse Traumatic Brain Injury. N Engl J Med. 2011; 364:1493-502. https://doi.org/10.1056/nejmoa1102077
https://doi.org/10.1056/NEJMoa1102077 DOI: https://doi.org/10.1056/NEJMoa1102077
Hutchinson PJ, Kolias AG, Timofeev IS, Corteen EA, Czosnyka M, Timothy J, et al. Trial of Decompressive Craniectomy for Traumatic Intracranial Hypertension. N Engl J Med. 2016; 375:1119-30. DOI: 10.1056/NEJMoa1605215
https://doi.org/10.1056/NEJMoa1605215 DOI: https://doi.org/10.1056/NEJMoa1605215
D'Andrea A, Conte M, Cavallaro M, Scarafile R, Riegler L, Coccg-hia R, et al. Transcranial Doppler ultrasound: physical principlesand principal applications in neurocritical care unit. J Cariovasc Echography. 2016; 26. https://doi.org/10.4103/2211-4122.183746
https://doi.org/10.4103/2211-4122.183746 DOI: https://doi.org/10.4103/2211-4122.183746
Zweifel C, Czosnyka M, Carrera E, de Riva N, Pickard J, Smie-lewski P. Reliability of the blood flow velocity pulsatility indexfor asseessment of intracranial and cerebral perfussion pressu-res in head-inmured patients. Neurosurgery. 2012; 71: 853-861. https://doi.org/10.1227/neu.0b013e3182675b42
https://doi.org/10.1227/NEU.0b013e3182675b42 DOI: https://doi.org/10.1227/NEU.0b013e3182675b42
Abadal JM, Llompart-Pou JA, Homar J, Pérez-Bárcena J, Ibáñez J. Aplicaciones del dúplex transcraneal codificado en color en la monitorización del enfermo neurocrítico [Applications of transcranial color-coded duplex sonography in monitoring neurocritical patients]. Med Intensiva. 2007 Dec;31(9):510-7. Spanish. doi: 10.1016/s0210-5691(07)74858-1
https://doi.org/10.1016/S0210-5691(07)74858-1 DOI: https://doi.org/10.1016/S0210-5691(07)74858-1
Bershad EM, Anand A, DeSantis SM, Yang M, Tang RA, Calvillo E, Malkin-Gosdin L, Foroozan R, Damani R, Maldonado N, Gupta P, Tan B, Venkatasubba Rao CP, Suarez JI, Clark JB, Sutton JP, Donoviel DB. Clinical Validation of a Transcranial Doppler-Based Noninvasive Intracranial Pressure Meter: A Prospective Cross-Sectional Study. World Neurosurg. 2016 May; 89: 647-653.e1. doi: 10.1016/j.wneu.2015.11.102
https://doi.org/10.1016/j.wneu.2015.11.102 DOI: https://doi.org/10.1016/j.wneu.2015.11.102
Prunet B, Asencio Y, Lacroix G, Montcriol A, Dagain A, Cotte J, Esnault P, Boret H, Meaudre E, Kaiser E. Noninvasive detection of elevated intracranial pressure using a portable ultrasound system. Am J Emerg Med. 2012 Jul;30(6):936-41. doi: 10.1016/j.ajem.2011.05.005
https://doi.org/10.1016/j.ajem.2011.05.005 DOI: https://doi.org/10.1016/j.ajem.2011.05.005
Chang T, Li L, Yang Y, Li M, Qu Y, Gao L. Transcranial Doppler Ultrasonography for the Management of Severe Traumatic Brain Injury After Decompressive Craniectomy. World Neurosurg. 2019 Jun;126:e116-e124. doi: 10.1016/j.wneu.2019.02.005
https://doi.org/10.1016/j.wneu.2019.02.005 DOI: https://doi.org/10.1016/j.wneu.2019.02.005
Robba C, Wong A, Poole D, Al Tayar A, Arntfield RT, Chew MS, Corradi F, Douflé G, Goffi A, Lamperti M, Mayo P, Messina A, Mongodi S, Narasimhan M, Puppo C, Sarwal A, Slama M, Taccone FS, Vignon P, Vieillard-Baron A; European Society of Intensive Care Medicine task force for critical care ultrasonography*. Basic ultrasound head-to-toe skills for intensivists in the general and neuro intensive care unit population: consensus and expert recommendations of the European Society of Intensive Care Medicine. Intensive Care Med. 2021 Dec;47(12):1347-1367. doi: 10.1007/s00134-021-06486-z
https://doi.org/10.1007/s00134-021-06486-z DOI: https://doi.org/10.1007/s00134-021-06486-z
Published
How to Cite
Issue
Section
License
Copyright (c) 2023 Cristhian Huanca; Alejandra Natalia Espinoza Marquéz; Rommer Alex Ortega Martinez
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License 4.0 that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.
