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Published on: March 26, 2019
Transcranial Doppler can predict intracranial hypertension in children with severe traumatic brain injuries
José Roberto Tude Melo1, Federico Di Rocco, Stéphane Blanot
1Department of Pediatric Neurosurgery, Hôpital Necker-Enfants Malades (Assistance Publique Hôpitaux de Paris, France), Université Descartes Paris 5, Paris, France. robertotude@gmail.com
Insights
Emergency Transcranial Doppler (TCD) accurately predicts intracranial hypertension in children with severe traumatic brain injury (TBI). This non-invasive tool helps identify children needing immediate, aggressive treatment and continuous monitoring.
Area of Science:
- Pediatric Neurology
- Neurocritical Care
- Trauma Surgery
Background:
- Severe traumatic brain injury (TBI) in children poses significant management challenges.
- Accurate and timely assessment of intracranial pressure (ICP) and cerebral perfusion pressure (CPP) is critical for optimal outcomes.
- Non-invasive monitoring methods are desirable to reduce risks associated with invasive procedures.
Purpose of the Study:
- To evaluate the diagnostic accuracy of emergency Transcranial Doppler (TCD) in predicting intracranial hypertension (ICH) and abnormal CPP in pediatric severe TBI.
- To assess TCD's utility as a first-line screening tool in this vulnerable patient population.
Main Methods:
- Retrospective cross-sectional study of 117 children with severe TBI (Glasgow Coma Scale ≤ 8).
- Emergency TCD performed on admission, assessing diastolic velocity and pulsatility index.
- Comparison of TCD findings with invasive ICP and CPP monitoring (gold standard) for ICH (ICP ≥ 20 mmHg) and abnormal CPP (<50 mmHg).
Main Results:
- TCD demonstrated 94% sensitivity for detecting ICH on admission.
- TCD showed a 95% negative predictive value for normal ICP.
- Sensitivity of TCD in predicting abnormal CPP was 80%.
Conclusions:
- Admission TCD is a highly sensitive, non-invasive tool for predicting ICH and abnormal CPP in children with severe TBI.
- TCD serves as an excellent first-line examination to guide urgent treatment decisions and identify candidates for invasive ICP monitoring.
Purpose:
The purpose of this study is to evaluate the accuracy of emergency Transcranial Doppler (TCD) to predict intracranial hypertension and abnormal cerebral perfusion pressure in children with severe traumatic brain injury (TBI).
Patients And Methods:
A descriptive and retrospective cross-sectional study was designed through data collected from medical records of children with severe TBI (Glasgow coma scale ≤ 8), admitted to a level I pediatric trauma center, between January 2000 and December 2005. Early TCD examination was performed upon admission, and TCD profiles were considered as altered using previously validated threshold values for diastolic velocity (<25 cm/s) and pulsatility index (>1.31) or when no-flow/backflow was detected. Invasive intracranial pressure (ICP) and cerebral perfusion pressure (CPP) monitoring were considered as the gold standard to measure intracranial hypertension (ICH). Statistical analyses compared TCD profiles to increased ICP (≥ 20 mmHg) and abnormal cerebral perfusion pressure (<50 mmHg) at admission.
Results:
Non-invasive TCD and ICP monitoring were performed in 117 severe head-injured children. Mean age was 7.6 ± 4.4 years, with a male prevalence (71%). Median initial Glasgow coma scale was 6. TCD had 94% of sensitivity to identify ICH at admission and a negative predict value of 95% to identify normal ICP at admission. Its sensitivity to predict abnormal cerebral perfusion pressure was 80%.
Conclusions:
The high sensitivity of admission TCD to predict ICH and abnormal CPP after trauma demonstrates that TCD is an excellent first-line examination to determine those children who need urgent aggressive treatment and continuous invasive ICP monitoring.
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