Intensive Care Medicine

, Volume 31, Issue 6, pp 785–790 | Cite as

Transcranial Doppler to detect on admission patients at risk for neurological deterioration following mild and moderate brain trauma

  • Paul Jaffres
  • Julien Brun
  • Philippe Declety
  • Jean-Luc Bosson
  • Bertrand Fauvage
  • Almuth Schleiermacher
  • Affif Kaddour
  • Daniel Anglade
  • Claude Jacquot
  • Jean-Francois Payen
Original

Abstract

Objective

To investigate the contribution of transcranial Doppler measurements obtained in the emergency room for detecting patients with secondary neurological deterioration after mild or moderate brain trauma.

Design and setting

Prospective cohort study in the emergency room in a university teaching hospital.

Patients

Seventy-eight adult patients admitted to the emergency room after a traumatic brain injury (TBI), including 42 patients with Glasgow Coma Score 14–15 and 36 with 9–13.

Measurements and results

All patients had transcranial Doppler measurements on both middle cerebral arteries and computed tomography on admission. Neurological outcome was assessed 7 days after trauma. Of the patients included 7 and 10 had secondary neurological deterioration after mild and moderate TBI, respectively. On admission these groups of patients had significantly more injuries on computed tomography using the Trauma Coma Data Bank classification and higher pulsatility index using transcranial Doppler than the patients having no subsequent neurological worsening.

Conclusions

Increased pulsatility index after mild or moderate TBI is a reason for concern about the possibility of further neurological deterioration. Computed tomography and Doppler measurements could be combined to detect on admission patients at risk for secondary neurological deterioration in order to improve their initial disposition.

Keywords

Traumatic brain injury Mild head injury Moderate head injury Transcranial Doppler 

Notes

Acknowledgements

The authors thank Dr. Marek Czosnyka for his helpful comments on the manuscript.

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Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • Paul Jaffres
    • 1
  • Julien Brun
    • 1
  • Philippe Declety
    • 1
  • Jean-Luc Bosson
    • 2
  • Bertrand Fauvage
    • 1
  • Almuth Schleiermacher
    • 3
  • Affif Kaddour
    • 3
  • Daniel Anglade
    • 1
  • Claude Jacquot
    • 1
  • Jean-Francois Payen
    • 1
  1. 1.Department of Anaesthesiology and Critical Care MedicineAlbert Michallon HospitalGrenobleFrance
  2. 2.Division of BiostatisticsAlbert Michallon HospitalGrenobleFrance
  3. 3.Department of Emergency MedicineAlbert Michallon HospitalGrenobleFrance

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