Transcranial Doppler ultrasonography at the admission of trauma head-injured patients and their neurological outcome at 3 months

Introduction

Early cerebral ischemia after brain trauma is predictive of poor outcome [1]. Since brain hemodynamics can be non-invasively assessed using transcranial Doppler ultrasonography (TCD), we prospectively investigated the relation between TCD measurements at the admission of head-injured patients and their neurological outcome at 3 months.

Methods

Twenty-nine head-injured patients (35 ± 16 years, Glasgow Coma Scale [GCS] 10 ± 4, Apache II score 35 ± 15) were included in the study, in the absence of systemic hypotension (systolic blood pressure > 90 mmHg), hypoxemia (SpO₂ > 92%) and PaCO₂ alterations (PaCO₂ 4–4.5 kPa) at the admission. TCD right and left middle cerebral artery systolic (SV), diastolic (DV) and mean (MV) flow velocities and pulsatility index (PI) were measured within the first 6 hours after the brain trauma (Waki 1-TC; ATYS Medical, Lyon, France). Neurological evaluation was performed at 3 months following the brain trauma, using the Glasgow Outcome Scale (GOS). A GOS score of 4 and 5 (moderate disability to total recovery) was considered as a good outcome (group 1), and a GOS score of 1–3 (death to severe disability) as a bad outcome (group 2). The Student t test was used to compare the data (mean ± SD), and P < 0.05 was considered significant.

Results

Nine patients had bad outcome at 3 months (five deaths, four GOS score of 3), and 20 had good outcome (five GOS score of 4, 15 GOS score of 5). At admission, there was no significative difference between the two groups in their age, the systemic blood pressure, the ventilatory parameters, and the GCS. G roup 2 exhibited lower DV and higher PI values than did group 1 (Table 1).

Table 1

Conclusions

Noninvasive estimation of brain hemodynamics by TCD at the admission of head-injured patients could be related to neurological status at 3 months. Further studies are needed to determine TCD threshold values of outcome.