title: Assessment of brain midline shift using sonography in neurosurgical ICU patients.
abstract: BACKGROUND
  Brain midline shift (MLS) is a life-threatening condition that requires urgent diagnosis and treatment. We aimed to validate bedside assessment of MLS with Transcranial Sonography (TCS) in neurosurgical ICU patients by comparing it to CT.
  
  
  METHODS
  In this prospective single centre study, patients who underwent a head CT were included and a concomitant TCS performed. TCS MLS was determined by measuring the difference between the distance from skull to the third ventricle on both sides, using a 2 to 4 MHz probe through the temporal window. CT MLS was measured as the difference between the ideal midline and the septum pellucidum. A significant MLS was defined on head CT as > 0.5 cm.
  
  
  RESULTS
  A total of 52 neurosurgical ICU patients were included. The MLS (mean ± SD) was 0.32 ± 0.36 cm using TCS and 0.47 ± 0.67 cm using CT. The Pearson's correlation coefficient (r(2)) between TCS and CT scan was 0.65 (P < 0.001). The bias was 0.09 cm and the limits of agreements were 1.10 and -0.92 cm. The area under the ROC curve for detecting a significant MLS with TCS was 0.86 (95% CI = 0.74 to 0.94), and, using 0.35 cm as a cut-off, the sensitivity was 84.2%, the specificity 84.8% and the positive likelihood ratio was 5.56.
  
  
  CONCLUSIONS
  This study suggests that TCS could detect MLS with reasonable accuracy in neurosurgical ICU patients and that it could serve as a bedside tool to facilitate early diagnosis and treatment for patients with a significant intracranial mass effect.
authors.affiliation: Anesthesiology and Critical Care Department, Equipe d'accueil "Modélisation de l'agression tissulaire et nociceptive", University Hospital of Toulouse, University Toulouse 3 Paul Sabatier, Toulouse, France. motuel.j@chu-toulouse.fr.
authors.forename: Julie
authors.initials: J
authors.lastname: Motuel
authors.affiliation: Neuroradiology Department, University Hospital of Toulouse, University Toulouse 3 Paul Sabatier, Toulouse, France. biette.i@chu-toulouse.fr.
authors.forename: Isaure
authors.initials: I
authors.lastname: Biette
authors.affiliation: Anesthesiology and Critical Care Department, Equipe d'accueil "Modélisation de l'agression tissulaire et nociceptive", University Hospital of Toulouse, University Toulouse 3 Paul Sabatier, Toulouse, France. srairi.m@chu-toulouse.fr.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Srairi
authors.affiliation: Anesthesiology and Critical Care Department, Equipe d'accueil "Modélisation de l'agression tissulaire et nociceptive", University Hospital of Toulouse, University Toulouse 3 Paul Sabatier, Toulouse, France. mrozek.s@chu-toulouse.fr.
authors.forename: Ségolène
authors.initials: S
authors.lastname: Mrozek
authors.affiliation: Department of Anesthesia, University of Toronto, Toronto, Canada. m.kurrek@utoronto.ca.
authors.forename: Matt M
authors.initials: MM
authors.lastname: Kurrek
authors.affiliation: Department of Neurosurgery, University Hospital of Toulouse, University Toulouse 3 Paul Sabatier, Toulouse, France. chaynes.p@chu-toulouse.fr.
authors.forename: Patrick
authors.initials: P
authors.lastname: Chaynes
authors.affiliation: Neuroradiology Department, University Hospital of Toulouse, University Toulouse 3 Paul Sabatier, Toulouse, France. cognard.c@chu-toulouse.fr.
authors.forename: Christophe
authors.initials: C
authors.lastname: Cognard
authors.affiliation: Anesthesiology and Critical Care Department, Equipe d'accueil "Modélisation de l'agression tissulaire et nociceptive", University Hospital of Toulouse, University Toulouse 3 Paul Sabatier, Toulouse, France. fourcade.o@chu-toulouse.fr.
authors.forename: Olivier
authors.initials: O
authors.lastname: Fourcade
authors.affiliation: Anesthesiology and Critical Care Department, Equipe d'accueil "Modélisation de l'agression tissulaire et nociceptive", University Hospital of Toulouse, University Toulouse 3 Paul Sabatier, Toulouse, France. geeraerts.t@chu-toulouse.fr.
authors.forename: Thomas
authors.initials: T
authors.lastname: Geeraerts
mesh_terms: D000328:Adult; D000368:Aged; D001921:Brain / Q000473:pathology / Q000601:surgery*; D004453:Echoencephalography / Q000379:methods / Q000592:standards*; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000592:standards*; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods / Q000592:standards*; D019095:Point-of-Care Systems / Q000592:standards*; D011446:Prospective Studies; D017585:Ultrasonography, Doppler, Transcranial / Q000379:methods / Q000592:standards*