Intensive Care Medicine

, Volume 30, Issue 1, pp 108–112 | Cite as

The prognostic value of transcranial Doppler studies in children with moderate and severe head injury

  • Fabien Trabold
  • Philippe G. Meyer
  • Stéphane Blanot
  • Pierre A. Carli
  • Gilles A. Orliaguet
Neonatal and Pediatric Intensive Care

Abstract

Objective

To assess the potency of transcranial Doppler (TCD) to predict prognosis in children with moderate and severe head trauma.

Design and setting

Prospective single-center study in a level I pediatric trauma center.

Patients

Thirty-six consecutive patients with a prehospital diagnosis of moderate or severe head trauma admitted over a 6-month period.

Interventions

On arrival in the emergency room, TCD was performed and peak systolic velocities, end-diastolic velocity and time-averaged mean velocity in the middle cerebral artery were recorded. Pulsatility and resistance index were calculated. The Pediatric Trauma Score (PTS), Glasgow Coma Scale (GCS) score and Injury Severity Score (ISS) were also calculated. Patient neurological outcome was determined using the Glasgow Outcome Scale (GOS) at discharge from hospital. GOS 1–2 were considered as “good prognosis” (group 1) and GOS 3–5 were considered as “poor prognosis” (group 2).

Results

Compared with group 1 patients, group 2 patients had a significantly lower mean GCS (5±3 vs 8±4, p<0.05) and PTS (2±2 vs 5±2), and a higher mean ISS (32±8 vs 19±11, p<0.05). An end-diastolic velocity less than 25 cm/s and a pulsatility index more than 1.31 were associated with a poor prognosis (p<0.05).

Conclusion

In children with moderate and severe head trauma, our data suggest an association between the results of TCD assessment on arrival in the emergency room and the outcome at discharge from the hospital.

Keywords

Transcranial Doppler Head trauma Children 

Notes

Acknowledgement

The authors wish to thank Dr. D.J. Baker, DM FRCA, of the Department of Anesthesiology, Hôpital Necker-Enfants Malades, Paris for editorial assistance.

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Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  • Fabien Trabold
    • 1
  • Philippe G. Meyer
    • 2
  • Stéphane Blanot
    • 2
  • Pierre A. Carli
    • 2
  • Gilles A. Orliaguet
    • 2
  1. 1.Department of Anesthesiology and Critical Care, Hôpital de Bicêtre, Le Kremlin BicêtreAssistance Publique-Hôpitaux de Paris, Université Paris XILe Kremlin-BicêtreFrance
  2. 2.Department of Anesthesiology and Critical Care, Hôpital Necker Enfants MaladesAssistance Publique-Hôpitaux de Paris, Université Paris VParis Cedex 15France

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