Role of noninvasive imaging techniques as outcome predictors in traumatic brain injury

Abstract

ObjectivesWe aimed to assess the predictive value of early transcranial Doppler (TCD) in patients with traumatic brain injury (TBI) in terms of secondary neurological insult and to establish the comparison between TCD and other diagnostic methods as predictors of outcome in those patients.BackgroundPatients with mild to moderate TBI are at risk of grave neurologic outcomes. Early use of TCD for these patients could be a good predictor.Patients and methodsThis prospective cohort study enrolled adult patients with mild and moderate TBI. Early TCD was done, and the peak systolic velocities, end-diastolic velocity, and time-averaged mean velocity in the middle cerebral artery were recorded. The pulsatility index and the resistance index were calculated. Secondary neurological deterioration (SND) was assessed on the seventh day from injury. Prognosis was also assessed by the Glasgow outcome scale (GOS) on the 28th day of admission.ResultsIn all, 120 patients were enrolled. Of these, 78 patients had SND, and 44 patients developed bad 28-day GOS. Age and severity of trauma (mild and moderate TBI) were significantly associated with both SND and bad GOS. TCD measurements were good predictors to detect patients at risk of SND and the 28-day GOS. Using receiver-operating characteristic analysis, the best threshold limit was found to be 25 cm/s for diastolic cerebral blood flow velocity and 1.2 for pulsatility index. Combination cutoffs of TCD parameters could be good predictors of SND.ConclusionEarly TCD measurements after mild to moderate TBI could predict patients at risk of SND and bad neurological outcome.