US EPA

3171927 

Journal Article 

Use of Transcranial Doppler in Patients with Severe Traumatic Brain Injuries 

Ziegler, DW; Cravens, G; Poche, G; Gandhi, R; Tellez, M 

2016 

Yes 

Journal of Neurotrauma
ISSN: 0897-7151
EISSN: 1557-9042 

English 

26913374 

10.1089/neu.2015.3967 

BACKGROUND: Severe traumatic brain injuries are associated with a high rate of mortality and disability. Transcranial Doppler sonography (TCD) permits a non-invasive measurement of cerebral blood flow. The purpose of this study is to determine the usefulness of TCD in patients with severe TBI.

METHODS: TCD were performed on 255 patients from April 2008 to April 2013 with severe TBI, defined as a Glasgow Coma Scale of 8 or less on admission. TCD were performed on hospital days 1, 2, 3 and 7. Hypoperfusion was defined by having two out of three of the following: 1. Mean velocity of the middle cerebral artery less than 35 cm/sec 2. Diastolic velocity of the middle cerebral artery less than 20 cm/sec 3. Pulsatility index of greater than 1.4 Vasospasm was defined by the following: mean velocity of the middle cerebral artery greater than 120 cm/sec and /or a Landegaarde index greater than 3.

RESULTS: One hundred fourteen (45%) had normal measurements. 92 (80.7%) had a good outcome, 6 (5.3%) had moderate disability and 16 (14%) died, 4 from brain death. Seventy two patients (28%) had hypoperfusion and 71 (98.6%) died, 65 from brain and one patient survived with moderate disability. Sixty nine patients (27%) had vasospasm, 31 (44.9%) had a good outcome, 16 (23.2%) had severe disability and 22 (31.9%) died, 13 from brain death. The vasospasm was detected on hospital day 1 in 8 patients, day 2 in 23 patients, day 3 in 22 patients and day 7 in 16 patients.

CONCLUSION: Patients with normal measurements can be expected to survive. Patients with hypoperfusion have a poor prognosis. Patients with vasospasm have a high incidence of mortality and severe disability. TCD is useful in determining early prognosis.