title: Transcranial Doppler to screen on admission patients with mild to moderate traumatic brain injury.
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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Anesthesia and Critical Care, Albert Michallon Hospital, Grenoble, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Bouzat
authors.forename: Gilles
authors.initials: G
authors.lastname: Francony
authors.forename: Philippe
authors.initials: P
authors.lastname: Declety
authors.forename: Céline
authors.initials: C
authors.lastname: Genty
authors.forename: Affif
authors.initials: A
authors.lastname: Kaddour
authors.forename: Pierre
authors.initials: P
authors.lastname: Bessou
authors.forename: Julien
authors.initials: J
authors.lastname: Brun
authors.forename: Claude
authors.initials: C
authors.lastname: Jacquot
authors.forename: Stephan
authors.initials: S
authors.lastname: Chabardes
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Bosson
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Payen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D001930:Brain Injuries / Q000000981:diagnostic imaging*; D002560:Cerebrovascular Circulation / Q000502:physiology; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012372:ROC Curve; D012307:Risk Factors; D012680:Sensitivity and Specificity; D017585:Ultrasonography, Doppler, Transcranial; D055815:Young Adult