title: Transcranial Doppler to Predict Neurologic Outcome after Mild to Moderate Traumatic Brain Injury.
abstract: BACKGROUND
  To assess the performance of transcranial Doppler (TCD) in predicting neurologic worsening after mild to moderate traumatic brain injury.
  
  
  METHODS
  The authors conducted a prospective observational study across 17 sites. TCD was performed upon admission in 356 patients (Glasgow Coma Score [GCS], 9 to 15) with mild lesions on cerebral computed tomography scan. Normal TCD was defined as a pulsatility index of less than 1.25 and diastolic blood flow velocity higher than 25 cm/s in the two middle cerebral arteries. The primary endpoint was secondary neurologic deterioration on day 7.
  
  
  RESULTS
  Twenty patients (6%) developed secondary neurologic deterioration within the first posttraumatic week. TCD thresholds had 80% sensitivity (95% CI, 56 to 94%) and 79% specificity (95% CI, 74 to 83%) to predict neurologic worsening. The negative predictive values and positive predictive values of TCD were 98% (95% CI, 96 to 100%) and 18% (95% CI, 11to 28%), respectively. In patients with minor traumatic brain injury (GCS, 14 to 15), the sensitivity and specificity of TCD were 91% (95% CI, 59 to 100%) and 80% (95% CI, 75 to 85%), respectively. The area under the receiver operating characteristic curve of a multivariate predictive model including age and GCS was significantly improved with the adjunction of TCD. Patients with abnormal TCD on admission (n = 86 patients) showed a more altered score for the disability rating scale on day 28 compared to those with normal TCD (n = 257 patients).
  
  
  CONCLUSIONS
  TCD measurements upon admission may provide additional information about neurologic outcome after mild to moderate traumatic brain injury. This technique could be useful for in-hospital triage in this context. (Anesthesiology 2016; 125:346-54).
authors.affiliation: From the Pôle Anesthésie Réanimation, CHU Grenoble Alpes, Grenoble, France (P.B., L.A., P.M., L.O., J.-F.P.); INSERM, Grenoble, France (P.B., J.-F.P.); Université Grenoble Alpes, Grenoble Institut des Neurosciences (GIN), Grenoble, France (P.B., J.-F.P.); Centre d'investigation clinique (P.M., S.T., J.-L. B.) and Service d'accueil des urgences chirurgicales (L.S.), CHU de Grenoble, Grenoble, France; Service de réanimation, Centre hospitalier Annecy Genevois, Annecy, France (A.L.); Département d'anesthésie réanimation, Hospices Civils de Lyon, Lyon, France (J.-S.D.); Département d'anesthésie réanimation, CHU de Nantes, Nantes, France (R. Cinotti); Département d'anesthésie réanimation, CHU de Clermont Ferrand, Clermont-Ferrand, France (R. Chabanne); Département de médecine d'urgence-SAMU-SMUR, CHU de Dijon, Dijon, France (A.G.); and Département d'anesthésie-réanimation-urgences, CHU de Nîmes, Nîmes, France (X.B.).Service d'anesthésie, réanimation chirurgicale, Hôtel Dieu, Centre Hospitalier Universitaire (CHU) Nantes, Nantes, FranceEmergency medical service, Hôtel Dieu, CHU Nantes, Nantes, FranceDépartement Anesthésie Réanimation Douleur Urgences, CHU de Nîmes, Nîmes, FranceDépartement d'Anesthésie Réanimation, CHU de Dijon, Dijon, FranceEmergency medical service, Saint Jean de Maurienne Hospital, Saint Jean de Maurienne, FranceEmergency medical service, Hôpitaux du Pays du Mont Blanc, Sallanches, FranceIntensive Care Unit, Chambery Hospital, Chambery, FranceEmergency medical service, Albertville-Moutiers Hospital, Albertville, FranceIntensive Care Unit, Besançon University Hospital, Besançon, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Bouzat
authors.forename: Luc
authors.initials: L
authors.lastname: Almeras
authors.forename: Pauline
authors.initials: P
authors.lastname: Manhes
authors.forename: Laurence
authors.initials: L
authors.lastname: Sanders
authors.forename: Albrice
authors.initials: A
authors.lastname: Levrat
authors.forename: Jean-Stephane
authors.initials: JS
authors.lastname: David
authors.forename: Raphael
authors.initials: R
authors.lastname: Cinotti
authors.forename: Russel
authors.initials: R
authors.lastname: Chabanne
authors.forename: Aurélie
authors.initials: A
authors.lastname: Gloaguen
authors.forename: Xavier
authors.initials: X
authors.lastname: Bobbia
authors.forename: Sophie
authors.initials: S
authors.lastname: Thoret
authors.forename: Lydia
authors.initials: L
authors.lastname: Oujamaa
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Bosson
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Payen
authors.forename: Karim
authors.initials: K
authors.lastname: Asehnoune
authors.forename: Philippe
authors.initials: P
authors.lastname: Pes
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Lefrant
authors.forename: Sébastien
authors.initials: S
authors.lastname: Mirek
authors.forename: François
authors.initials: F
authors.lastname: Albasini
authors.forename: Caron
authors.initials: C
authors.lastname: Scrimgeour
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Thouret
authors.forename: Freddy
authors.initials: F
authors.lastname: Chartier
authors.forename: Marc
authors.initials: M
authors.lastname: Ginet
mesh_terms: D000328:Adult; D000070642:Brain Injuries, Traumatic / Q000150:complications* / Q000000981:diagnostic imaging*; D002560:Cerebrovascular Circulation; D023381:Endpoint Determination; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000000981:diagnostic imaging* / Q000209:etiology*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D017585:Ultrasonography, Doppler, Transcranial / Q000379:methods*