Role of transcranial Doppler ultrasound in early assessment of acute post-traumatic brain injury

Traumatic brain injury (TBI) represents a significant global health and socioeconomic burden. This research aims to assess the accuracy of transcranial Doppler (TCD) ultrasound in the early assessment of cerebral blood flow following acute TBI and its utility as an early predictor of neurological outcomes, in correlation with computed tomography findings. A comparative study was conducted on 55 adult patients with acute TBI admitted to Helwan University Hospital between October 2021 and April 2023. TCD was performed within 8 hours post-trauma, and patients were monitored for secondary neurological deterioration (SND) at day 7 and for in-hospital mortality. Nineteen patients (34.5%) developed SND. These patients showed significantly higher admission Rotterdam and Marshall computed tomography scores (P < .001), lower end-diastolic velocity and mean flow velocities (P < .05), and higher pulsatility index (P < .001). Peak systolic velocity showed no significant difference. Receiver operating characteristic analysis identified pulsatility index and end-diastolic velocity as strong predictors of SND at day 7 post-trauma, with area under the curves of 0.923 and 0.884, sensitivity of 87.95% and 73.68%, specificity of 97.2% and 88.89%, and accuracy of 90.9% and 83.6%, respectively. A substantial proportion of TBI patients studied experienced SND within the initial 7 days following trauma. Early TCD assessment offers a valuable, noninvasive tool for identifying patients at risk, aiding in clinical triage and management.