Transcranial Doppler as an early predictor of neurological outcome in mild and moderate traumatic brain injury: An observational study

Abstract

Background: Traumatic brain injury (TBI) is a major cause of disability and mortality globaly. The transcranial Doppler (TCD) method may show low diastolic blood flow velocity (FVd) and high pulsatility index (PI) measurements brought on by high vascular bed resistance. This study aimed to assess the usefulness of the TCD-PI for the early detection of secondary neurological deterioration (SND) in mild and moderate TBI. Materials and Methods: This prospective study was carried out on 105 mild and moderate TBI patients, who had TCD measurements within 12 h of the initial trauma, and initial computerized tomography (CT) showed mild lesion or no detected abnormality. Results: Primary end point was assessed (SND) within 1st week post trauma. Of the 105 patients with mild and moderate TBI, 29 (27.6%) showed SND. We evaluated the value of our intervention (TCD) to predict SND after mild and moderate TBI in 1st week. PI could predict SND at cutoff 1.21 with good sensitivity of 96.5% and specificity of 94.7%, area under curve (AUC) value of 0.98, negative predictive value (NPV) of 98.6%, and positive predictive value (PPV) of 87.5%. To amplify our finding, we measured FVd, and at 25 cm/s it showed good sensitivity 86.2% and specificity 89.5% when AUC 0.93, NPV 94.4%, and PPV 75.8%. Conclusion: TCD on admission may provide a valuable tool of early prediction of neurological outcome for mild and moderate TBI patients. Closing the gap in poor prediction of commonly used evaluation by CT especially with mild lesion.