title: Pre-hospital transcranial Doppler in severe traumatic brain injury: a pilot study.
abstract: BACKGROUND
  Investigation of the feasibility and usefulness of pre-hospital transcranial Doppler (TCD) to guide early goal-directed therapy following severe traumatic brain injury (TBI).
  
  
  METHODS
  Prospective, observational study of 18 severe TBI patients during pre-hospital medical care. TCD was performed to estimate cerebral perfusion in the field and upon arrival at the Level 1 trauma centre. Specific therapy (mannitol, noradrenaline) aimed at improving cerebral perfusion was initiated if the initial TCD was abnormal (defined by a pulsatility index >1.4 and low diastolic velocity).
  
  
  RESULTS
  Nine patients had a normal initial TCD and nine an abnormal one, without a significant difference between groups in terms of the Glasgow Coma Scale or the mean arterial pressure. Among patients with an abnormal TCD, four presented with an initial areactive bilateral mydriasis. Therapy normalized TCD in five patients, with reversal of the initial mydriasis in two cases. Among these five patients for whom TCD was corrected, only two died within the first 48 h. All four patients for whom the TCD could not be corrected during transport died within 48 h. Only patients with an initial abnormal TCD required emergent neurosurgery (3/9). Mortality at 48 h was significantly higher for patients with an initial abnormal TCD.
  
  
  CONCLUSIONS
  Our preliminary study suggests that TCD could be used in pre-hospital care to detect patients whose cerebral perfusion may be impaired.
authors.affiliation: Service d'aide médicale urgente (SAMU) 77, Pôle Urgence, Hôpital Marc Jacquet, Melun, France. karim.tazarourte@ch-melun.fr
authors.forename: K
authors.initials: K
authors.lastname: Tazarourte
authors.forename: A
authors.initials: A
authors.lastname: Atchabahian
authors.forename: J-P
authors.initials: JP
authors.lastname: Tourtier
authors.forename: J-S
authors.initials: JS
authors.lastname: David
authors.forename: C
authors.initials: C
authors.lastname: Ract
authors.forename: D
authors.initials: D
authors.lastname: Savary
authors.forename: M
authors.initials: M
authors.lastname: Monchi
authors.forename: B
authors.initials: B
authors.lastname: Vigué
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure / Q000502:physiology; D001926:Brain Death; D001930:Brain Injuries / Q000000981:diagnostic imaging* / Q000401:mortality / Q000503:physiopathology; D002560:Cerebrovascular Circulation / Q000502:physiology; D004632:Emergency Medical Services; D005260:Female; D015600:Glasgow Coma Scale; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015878:Mydriasis / Q000000981:diagnostic imaging / Q000628:therapy; D010865:Pilot Projects; D017585:Ultrasonography, Doppler, Transcranial; D055815:Young Adult