title: Transcranial Doppler to detect on admission patients at risk for neurological deterioration following mild and moderate brain trauma.
abstract: OBJECTIVE
  To investigate the contribution of transcranial Doppler measurements obtained in the emergency room for detecting patients with secondary neurological deterioration after mild or moderate brain trauma.
  
  
  METHODS
  Prospective cohort study in the emergency room in a university teaching hospital.
  
  
  METHODS
  Seventy-eight adult patients admitted to the emergency room after a traumatic brain injury (TBI), including 42 patients with Glasgow Coma Score 14-15 and 36 with 9-13.
  
  
  RESULTS
  All patients had transcranial Doppler measurements on both middle cerebral arteries and computed tomography on admission. Neurological outcome was assessed 7 days after trauma. Of the patients included 7 and 10 had secondary neurological deterioration after mild and moderate TBI, respectively. On admission these groups of patients had significantly more injuries on computed tomography using the Trauma Coma Data Bank classification and higher pulsatility index using transcranial Doppler than the patients having no subsequent neurological worsening.
  
  
  CONCLUSIONS
  Increased pulsatility index after mild or moderate TBI is a reason for concern about the possibility of further neurological deterioration. Computed tomography and Doppler measurements could be combined to detect on admission patients at risk for secondary neurological deterioration in order to improve their initial disposition.
authors.affiliation: Department of Anaesthesiology and Critical Care Medicine, Albert Michallon Hospital, 38043 Grenoble, France.
authors.forename: Paul
authors.initials: P
authors.lastname: Jaffres
authors.forename: Julien
authors.initials: J
authors.lastname: Brun
authors.forename: Philippe
authors.initials: P
authors.lastname: Declety
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Bosson
authors.forename: Bertrand
authors.initials: B
authors.lastname: Fauvage
authors.forename: Almuth
authors.initials: A
authors.lastname: Schleiermacher
authors.forename: Affif
authors.initials: A
authors.lastname: Kaddour
authors.forename: Daniel
authors.initials: D
authors.lastname: Anglade
authors.forename: Claude
authors.initials: C
authors.lastname: Jacquot
authors.forename: Jean-Francois
authors.initials: JF
authors.lastname: Payen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001930:Brain Injuries / Q000000981:diagnostic imaging*; D016022:Case-Control Studies; D018450:Disease Progression; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012044:Regression Analysis; D017585:Ultrasonography, Doppler, Transcranial