Ultrasound predictors of outcome of traumatic brain injury

Abstract

Objective. To evaluate the possibility of ultrasound monitoring of optic nerve sheath diameter and blood flow velocity in cerebral arteries as predictors of craniocerebral trauma outcome. Materials and methods. 35 patients with traumatic brain injury (TBI) were produced ultrasound monitoring of the optic nerve sheath diameter (ONSD) and blood flow velocity (BFV) in the middle cerebral artery (AMC) before surgery and for 10 days after craniotomy. A comparative analysis of blood flow in the A MC and ONSD was carried out between groups of patients with a favorable (group 1) and unfavorable (group 2) outcome of TBI. Results. Between the groups of patients with different outcome`s TBI, significant differences were revealed in the diameter of the optic nerve sheaths at the preoperative period and in the diastolic blood flow velocity in the MCA on the 9th day after surgery. In group 1, the ONSD was 4.7 [4.5; 5.1] mm, and in group 2 – 5.6 [5.4; 6] mm, p=0.003. On the 9th day after surgery, BFV at diastole in group 1 was 43.9 [38.7; 49.4] cm/sec, in group 2 – 28.7 [24.8; 36.7] cm/sec, p = 0.001. For ONSD in the preoperative period as a predictor of unfavorable outcome of TBI AUC=0.83, Se=88.8%, Sp=61.2%. For diastolic BFV in the AMC on the 9th day after surgery – AUC = 0.84, Se=93%, Sp = 52 %. Conclusion. In patients with traumatic brain injury, ultrasound examination shows that the diameter of the optic membranes before surgery is ≥5.6 mm and the blood flow velocity in the middle cerebral artery in diastole ≤28.7 cm/sec can be considered as predictors of an unfavorable outcome of TBI.