Title: Role of Transcranial Doppler Ultrasound as a Predictor of Outcome in Severe Traumatic Brain Injury and Its Correlation with Glascow Coma Scale and Full Outline of Unresponsiveness Score
Authors: Taysser Zaytoun, Akram Fayed, Ahmed Elbeheiry, Tarek Elsefi
DOI: https://dx.doi.org/10.18535/jmscr/v5i4.66
Abstract
Introduction: Traumatic brain injury(TBI) is a major public health problem. It is considered to be one of the leading causes of death and disability worldwide. After TBI cerebral blood flow (CBF) becomes extremely low approaching ischemic thresholds. Concurrently, cerebral blood flow velocities become strongly correlated to CBF itself post injury. Identification of such hemodynamic disturbances can be used to predict outcome in severe TBI when measured immediately post-injury using Transcranial Doppler (TCD). TCDpermits non invasive assessment of different CBF velocities as well as pulsatility index (PI). Abnormal measurement of such indices is believed to correlate to poor outcome.
Methods: 120 patients with severe TBI, according to GCS, underwent TCD within 24 hours post trauma. Middle cerebral artery (MCA) velocities and pulsatility index, as well as other clinical and neuro imaging data, were recorded and accordingly patients were divided into 3 groups: patients with normal TCD measurements, patients with hypoperfusion and patients with vasospasm. Hypoperfusion was defined by meeting two out of three criteria: mean flow velocity (MFV) of MCA< 35cm/sec, End diastolic velocity (EDV) of MCA<20cm/sec, PI>1.4. Vasospasm was defined as MFV>120 cm/sec. Outcome was evaluated using the Glasgow Outcome Scale extended(GOSE) at 3 months, as well as in-hospital mortality.TCD measurements were also correlated to GCS and FOUR score.
Result: There was a significant correlation between PI and GOSE at 3 months. There was also significant correlation between PI and mortality. However, different MCA velocities did not show any correlation with GOSE or mortality. Strong negative correlation was recognized between PI and GCS and FOUR scores.
Conclusion: Pulsatility index, when measured within the first 24 hours post-trauma, is considered a good predictor of mortality as well as functional outcome at 3months. Abnormal pulsatility index values correlate with the severity of injury (in terms of GCS and FOUR scores).
Key Words: Critical; Trauma; Injury; Transcranial; Doppler
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