Role of Transcranial Doppler Ultrasound in Early Assessment of Acute Post Traumatic Brain Injury

Abstract Introduction Traumatic brain injury (TBI) is a global health and socioeconomic problem. It is responsible of millions of ED visits, hospitalizations, and deaths with lifelong disability among survivors. Immediately after TBI, cerebral blood flow (CBF) is extremely low approaching the ischemic thresholds. Concurrently, CBF velocities become strongly correlated to CBF itself. Identification of such disturbances can predict outcome in TBI when assessed early post- injury using Transcranial Doppler (TCD). TCD provides non-invasive real time measurements of CBF velocities as well as pulsatility index (PI). Design Observational prospective cohort study. Setting Helwan university hospital. Aim to assess the accuracy of transcranial Doppler ultrasound as an early predictor of secondary neurological deterioration after acute post traumatic brain injury Patients and Methods 55 patients of acute post traumatic brain injury underwent TCD within 8 hours post trauma. Middle cerebral artery (MCA) velocities and pulsatility index, as well as GCS and initial CT findings, were recorded. The primary end point was the development of secondary neurological deterioration (SND) at day 7 after injury. Secondary outcome measures were the in-hospital mortality and hospital length of stay. Results There was a significant relation between end diastolic velocity (EVD) as well as PI with SND at day 7 as well as GOSE at day 28 post-trauma. There was also significant correlation between PI and hospital mortality. Conclusion TCD, when done early after admission, is useful in identifying patients at risk for developing neurological deterioration after TBI. EDV and PI are good predictors of SND at one week.as well as in-hospital mortality.