Transcranial Doppler Ultrasound Use in Pediatric Patients With Penetrating Traumatic Brain Injuries

Abstract

The purpose of this article is to increase awareness of the usefulness of transcranial Doppler (TCD) ultrasound as a noninvasive neuromonitor and bedside ultrasound in pediatric patients who have experienced a penetrative traumatic brain injury (TBI) as a result of a firearm. To date, the use of TCD is not standard of care in pediatric TBI patients. TCD is a portable ultrasound that can be performed in any care environment. The use of TCD in pediatric TBI studies have demonstrated abnormalities in cerebral blood flow velocity, autoregulation, and embolic events; all of which have been associated with poor neurocognitive and functional outcomes. A penetrating brain injury as a result of a firearm is associated with ongoing vascular injury and thereby an increased risk for poor neurologic sequelae. We discuss two exemplars of TCD use in children who experienced a firearm-related penetrating TBI and their TCD findings. Both exemplars identified the unique insights provided by TCD that were unappreciated by clinical observation. This article provides early evidence for the use of TCD as a neuromonitor in pediatric penetrating TBI.