title: A novel decision tree approach based on transcranial Doppler sonography to screen for blunt cervical vascular injuries.
abstract: OBJECTIVE
  Early detection and treatment of blunt cervical vascular injuries prevent adverse neurologic sequelae. Current screening criteria can miss up to 22% of these injuries. The study objective was to investigate bedside transcranial Doppler sonography for detecting blunt cervical vascular injuries in trauma patients using a novel decision tree approach.
  
  
  METHODS
  This prospective pilot study was conducted at a level I trauma center. Patients undergoing computed tomographic angiography for suspected blunt cervical vascular injuries were studied with transcranial Doppler sonography. Extracranial and intracranial vasculatures were examined with a portable power M-mode transcranial Doppler unit. The middle cerebral artery mean flow velocity, pulsatility index, and their asymmetries were used to quantify flow patterns and develop an injury decision tree screening protocol. Student t tests validated associations between injuries and transcranial Doppler predictive measures.
  
  
  RESULTS
  We evaluated 27 trauma patients with 13 injuries. Single vertebral artery injuries were most common (38.5%), followed by single internal carotid artery injuries (30%). Compared to patients without injuries, mean flow velocity asymmetry was higher for single internal carotid artery (P = .003) and single vertebral artery (P = .004) injuries. Similarly, pulsatility index asymmetry was higher in single internal carotid artery (P = .015) and single vertebral artery (P = .042) injuries, whereas the lowest pulsatility index was elevated for bilateral vertebral artery injuries (P = .006). The decision tree yielded 92% specificity, 93% sensitivity, and 93% correct classifications.
  
  
  CONCLUSIONS
  In this pilot feasibility study, transcranial Doppler measures were significantly associated with the blunt cervical vascular injury status, suggesting that transcranial Doppler sonography might be a viable bedside screening tool for trauma. Patient-specific hemodynamic information from transcranial Doppler assessment has the potential to alter patient care pathways to improve outcomes.
authors.affiliation: Department of Neuroscience, George Mason University, Fairfax, VA 22030, USA.
authors.forename: Dianna
authors.initials: D
authors.lastname: Purvis
authors.forename: Tayseer
authors.initials: T
authors.lastname: Aldaghlas
authors.forename: Amber W
authors.initials: AW
authors.lastname: Trickey
authors.forename: Anne
authors.initials: A
authors.lastname: Rizzo
authors.forename: Siddhartha
authors.initials: S
authors.lastname: Sikdar
mesh_terms: D000328:Adult; D000465:Algorithms; D020214:Cerebrovascular Trauma / Q000000981:diagnostic imaging*; D002574:Cervical Vertebrae / Q000098:blood supply / Q000000981:diagnostic imaging / Q000293:injuries; D020000:Decision Support Systems, Clinical; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D010865:Pilot Projects; D011446:Prospective Studies; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D017585:Ultrasonography, Doppler, Transcranial; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging*
keywords: blunt cervical vascular injury; classification and regression tree; transcranial Doppler sonography; trauma