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Transcranial Doppler Use in Non-traumatic Critically Ill Children: A Multicentre Descriptive Study
Virginie Rollet-Cohen1, Philippe Sachs2, Pierre-Louis Léger3
1Paediatric Intensive Care Unit, Necker-Enfants Malades University Hospital, Assistance Publique des Hôpitaux de Paris, Paris, France.
Frontiers in Pediatrics
|July 19, 2021
Summary
Transcranial Doppler (TCD) is frequently used in French pediatric intensive care units for neurological monitoring. While physicians find TCD valuable for clinical decisions, its objective impact on patient care requires further study.
Area of Science:
- Pediatric Critical Care Medicine
- Neurology
- Medical Imaging
Background:
- Limited documentation exists on the utilization and perceived value of transcranial Doppler (TCD) in pediatric critical care.
- This study addresses the gap by examining TCD use in French pediatric intensive care units (PICUs).
Purpose of the Study:
- To describe the application of transcranial Doppler (TCD) for assessing non-traumatic brain injuries in critically ill children.
- To evaluate the perceived clinical utility of TCD by physicians in PICUs.
Main Methods:
- Prospective study of pediatric patients (<18 years) undergoing inpatient TCD in four French PICUs from November 2014 to October 2015.
- Physician questionnaires completed within 4 hours of TCD to gather data on indications, timing, and perceived value.
- Analysis of 152 TCD assessments, focusing on diagnostic indications and concordance with normative values.
Main Results:
- Neurological diseases were the primary diagnosis in 70% of 152 included patients, with ischemic-anoxic brain insult being common.
- TCD served as the first-line neuromonitoring in 72% of cases, often performed within 24 hours of admission.
- Physicians reported TCD as valuable for clinical management in 86% of patients, despite only 28% concordance with normative values for abnormal findings.
Conclusions:
- Transcranial Doppler (TCD) is widely adopted in French PICUs for early neuromonitoring across diverse pediatric critical conditions.
- Physician-reported value highlights TCD's role in clinical decision-making.
- Further objective research is needed to ascertain TCD's definitive contribution to patient management and outcomes due to interpretation subjectivity.
