Clinical Value of Cerebral Blood Flow Decline and Enlarged Optic Nerve Sheath Diameter With Neurological Outcome After Severe Brain Injury

ABSTRACT Background It is challenging to assess the neurologic outcome of severe brain injury (SBI) patients in the intensive care unit (ICU). The combination of transcranial color‐coded duplex ultrasonography (TCCD) and optic nerve sheath diameter (ONSD) has potential as a valuable tool to evaluate the clinical outcome for SBI patients. Methods This is a retrospective observational study that consecutively enrolled 46 patients with SBI who were followed up 6 months for prognosis after discharging from the ICU. The primary study endpoint was the 6‐month function outcome assessed with the Glasgow Outcome Score (GOS). According to the outcome, patients were divided into the favorable group (GOS 4–5, n = 34) and the unfavorable group (GOS 1–3, n = 12). Results Significant differences between the two groups were found in the blood sodium level and Doppler parameters, such as the peak systolic velocity (PSV), end‐diastolic velocity (EDV), pulsatility index (PI) of middle cerebral artery (MCA), and bilateral ONSD ( p < 0.05 for all). Based on the Doppler parameters by TCCD and ONSD, ROC analysis demonstrated a good outcome prediction, with an area under the curve (AUC): 0.858, sensitivity: 71.0%, and specificity: 88.0%. Thresholds for unfavorable outcomes were 15.28 cm/s EDV and 0.45 cm ONSD in the first 7 days. Conclusions The cerebral blood flow decline detected by TCCD, combined with enlarged ONSD, may be a potential means to predict the poor outcomes of SBI patients safely and noninvasively in the ICU in an early time.