title: Transcranial Color Duplex Ultrasound: A Reliable Tool for Cerebral Hemodynamic Assessment in Brain Injuries.
abstract: BACKGROUND
  Transcranial color duplex ultrasound (TCCD) is becoming an important tool for cerebral monitoring of brain-injured patients. To date, TCCD reproducibility has been studied in healthy volunteers or patients with subarachnoid hemorrhage and its efficiency in many brain injuries has not been proved. Our aim was to evaluate TCCD interobserver agreement in different brain injuries.
  
  
  METHODS
  We performed a prospective monocentric trial conducted from January 2014 to September 2014 in intensive care unit (ICU) of Saint-Etienne university teaching hospital, France.Brain-damaged patients admitted in ICU were included, excluding those with decompressive craniectomy. Two randomized operators among the ICU medical staff consecutively performed measurements of cerebral blood flow velocities with TCCD.
  
  
  RESULTS
  One hundred measurements were obtained from 42 patients. Hemodynamic and end-tidal CO2 pressure were similar between both measurement set. The results obtained with the Bland-Altman method showed bias at 0.52 (95% confidence interval [CI], -4.19 to 3.16), 0.53 (95% CI, -1.86 to 2.92), and 0.002 (95% CI, -0.06 to 0.06) for mean velocity, diastolic velocity, and pulsatility index, respectively. The limits of agreement were (-32.4; 31.4), (-20.4; 21.4), (-0.5; 0.5) for mean velocity, diastolic velocity, and pulsatility index, respectively. The Passing and Bablok regression have shown a quasilinear relationship between measurements.
  
  
  CONCLUSIONS
  We reported the reliability of TCCD interobserver agreement in brain-damaged patients.
authors.affiliation: Department of Anesthesiology and Critical Care, University Hospital of Saint Etienne, Saint-Étienne Cedex, France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Dupont
authors.forename: Laetitia
authors.initials: L
authors.lastname: Burnol
authors.forename: Richard
authors.initials: R
authors.lastname: Jospe
authors.forename: Terrana
authors.initials: T
authors.lastname: Raphael
authors.forename: Christian
authors.initials: C
authors.lastname: Auboyer
authors.forename: Serge
authors.initials: S
authors.lastname: Molliex
authors.forename: Laurent
authors.initials: L
authors.lastname: Gergelé
authors.forename: Jérôme
authors.initials: J
authors.lastname: Morel
mesh_terms: D000368:Aged; D001930:Brain Injuries / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D002245:Carbon Dioxide / Q000097:blood; D002560:Cerebrovascular Circulation; D003422:Critical Care; D056424:Decompressive Craniectomy; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011446:Prospective Studies; D015203:Reproducibility of Results; D017585:Ultrasonography, Doppler, Transcranial / Q000379:methods*
chemical_list: D002245:Carbon Dioxide