Use of Transcranial Doppler in Patients with Severe Traumatic Brain Injuries

Area of Science:

• Neurology
• Critical Care Medicine
• Medical Imaging

Background:

• Severe traumatic brain injuries (TBI) are a leading cause of mortality and long-term disability.
• Noninvasive monitoring of cerebral blood flow is crucial for managing TBI patients.
• Transcranial Doppler (TCD) sonography offers a noninvasive method to assess cerebral hemodynamics.

Purpose of the Study:

• To evaluate the utility of Transcranial Doppler (TCD) sonography in predicting outcomes for patients with severe traumatic brain injuries (TBI).
• To correlate TCD findings with patient mortality and disability levels.

Main Methods:

• A prospective study involving 255 severe TBI patients (Glasgow Coma Scale ≤8) from April 2008 to April 2013.
• TCD measurements of middle cerebral artery velocity, pulsatility index, and Lindegaard index were performed on hospital days 1, 2, 3, and 7.
• Hypoperfusion and vasospasm were defined using specific velocity and index criteria.

Main Results:

• 45% of patients had normal TCD measurements, with 80.7% experiencing good outcomes.
• 28% of patients exhibited hypoperfusion, with a 98.6% mortality rate.
• 27% of patients showed vasospasm, associated with a 31.9% mortality rate and high incidence of severe disability.

Conclusions:

• TCD sonography is a valuable tool for early prognosis determination in severe TBI.
• Normal TCD findings are associated with a higher likelihood of survival.
• Hypoperfusion and vasospasm detected by TCD indicate a poor prognosis and increased risk of mortality or severe disability.