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Updated: Sep 21, 2026
Systems Analysis of the Neuroinflammatory and Hemodynamic Response to Traumatic Brain Injury
Published on: May 27, 2022
Association between Day-to-Day Pulsatility Index Change and Neurocognitive Outcomes in Pediatric Traumatic Brain
Jeremy Jordan1,2, Sigrid Ladores1, Michele Kong2,3
1School of Nursing, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Insights
Day-to-day changes in cerebral blood flow pulsatility indices (PIs) may indicate secondary injury in children with traumatic brain injury (TBI). Greater PI variation correlated with poorer neurocognitive outcomes, suggesting PIs as a potential biomarker.
Area of Science:
- Pediatric Neurology
- Neurocritical Care
- Cerebrovascular Physiology
Background:
- Traumatic brain injury (TBI) is a leading cause of childhood morbidity and mortality.
- Transcranial Doppler (TCD) ultrasound measures cerebral blood flow using pulsatility indices (PIs), but their role in pediatric TBI is unclear.
- Assessing cerebral vascular changes is crucial for understanding TBI progression and outcomes in children.
Purpose of the Study:
- To define day-to-day (DTD) pulsatility index (PI) changes in the anterior cerebral circulation of pediatric TBI patients.
- To investigate the relationship between DTD PI changes and injury characteristics (severity, sidedness).
- To explore the association between DTD PI variation and neurocognitive outcomes in pediatric TBI.
Main Methods:
- Prospective observational study of 42 children (2 months to 15 years) with mild or moderate-severe TBI.
- Serial Transcranial Doppler (TCD) ultrasound measurements to calculate pulsatility indices (PIs).
- Analysis of mean and variation of day-to-day (DTD) PI changes in relation to injury factors and neurocognitive outcomes.
Main Results:
- A larger mean DTD PI change in unilateral injuries correlated with worse Glasgow Outcome Scale-Extended Pediatrics scores.
- Increased variation in PI was associated with poorer neurocognitive outcomes, regardless of injury severity.
- DTD PI change demonstrated potential as a biomarker for secondary injury in pediatric TBI.
Conclusions:
- Mean and variation of DTD PI change may serve as cerebral vascular biomarkers in pediatric TBI.
- PI measurements could offer new diagnostic and prognostic insights for clinicians.
- Further research is needed to confirm findings and explore mechanistic links in larger pediatric TBI cohorts.
Abstract:
Traumatic brain injury (TBI) remains a significant cause of morbidity and mortality in children despite advances in prevention and mitigation strategies. Transcranial Doppler (TCD) ultrasound measures cerebral arterial circulation and allows for the calculation of pulsatility indices (PIs), which provides an assessment of cerebral blood flow changes. Yet, the use of PIs in children with TBI is not well understood. In this study, we defined the day-to-day (DTD) PI change of the anterior cerebral circulation and describe its relationship with injury characteristics and neurocognitive outcomes in children with TBI. A prospective observational parent study of 42 children, 2 months to 15 years of age, with mild or moderate-severe TBI who had serial TCDs provided data for this analysis. Both the mean and variation of DTD PI change were evaluated in the context of injury severity, injury sidedness, and neurocognitive outcome. In those with a unilateral injury, a larger mean DTD PI change in both the injured and uninjured side was found in those with a worse Glasgow Outcome Scale-Extended Pediatrics score at discharge. A larger variation in PI was associated with a worse neurocognitive outcome, irrespective of injury severity. Therefore, the mean and variation of DTD PI change may serve as a potential cerebral vascular biomarker of ongoing secondary injury. The use of PI measurements in the monitoring of children with TBI may provide clinicians with new diagnostic and prognostic insights to inform therapeutic interventions and recovery strategies. However, a larger prospective study is needed to confirm these findings and elucidate potential mechanistic links between DTD PI and clinical outcome measures. To our knowledge, this study is the first of its kind to evaluate the use of PI changes in cerebral vasculature in pediatric TBI patients admitted to the hospital.
