Skip to main content

Advertisement

SpringerLink
Log in

Transcranial Doppler can predict intracranial hypertension in children with severe traumatic brain injuries

  • Original Paper
  • Published:
Child's Nervous System Aims and scope Submit manuscript

Abstract

Purpose

The purpose of this study is to evaluate the accuracy of emergency Transcranial Doppler (TCD) to predict intracranial hypertension and abnormal cerebral perfusion pressure in children with severe traumatic brain injury (TBI).

Patients and methods

A descriptive and retrospective cross-sectional study was designed through data collected from medical records of children with severe TBI (Glasgow coma scale ≤8), admitted to a level I pediatric trauma center, between January 2000 and December 2005. Early TCD examination was performed upon admission, and TCD profiles were considered as altered using previously validated threshold values for diastolic velocity (<25 cm/s) and pulsatility index (>1.31) or when no-flow/backflow was detected. Invasive intracranial pressure (ICP) and cerebral perfusion pressure (CPP) monitoring were considered as the gold standard to measure intracranial hypertension (ICH). Statistical analyses compared TCD profiles to increased ICP (≥20 mmHg) and abnormal cerebral perfusion pressure (<50 mmHg) at admission.

Results

Non-invasive TCD and ICP monitoring were performed in 117 severe head-injured children. Mean age was 7.6 ± 4.4 years, with a male prevalence (71%). Median initial Glasgow coma scale was 6. TCD had 94% of sensitivity to identify ICH at admission and a negative predict value of 95% to identify normal ICP at admission. Its sensitivity to predict abnormal cerebral perfusion pressure was 80%.

Conclusions

The high sensitivity of admission TCD to predict ICH and abnormal CPP after trauma demonstrates that TCD is an excellent first-line examination to determine those children who need urgent aggressive treatment and continuous invasive ICP monitoring.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Anderson VA, Catroppa C, Haritou F, Morse S, Pentland L, Rosenfeld J, Stargatt R (2001) Predictors of acute child and family outcome following traumatic brain injury in children. Pediatr Neurosurg 34:138–348

    Article  PubMed  CAS  Google Scholar 

  2. Chiaretti A, Piastra M, Pulitano S, Pietrini D, De Rosa G, Barbaro R, Di Rocco C (2002) Prognostic factors and outcome of children with severe head injury: an 8-year experience. Childs Nerv Syst 18:129–136

    Article  PubMed  Google Scholar 

  3. Melo JRT, Silva RA, Moreira ED Jr (2004) Characteristics of patients with head injury at Salvador City (Bahia-Brazil). Arq Neuropsiquiatr 62:711–714

    Article  PubMed  Google Scholar 

  4. Melo JRT, de Santana DL, Pereira JL, Ribeiro TF (2006) Traumatic brain injury in children and adolescents at Salvador City, Bahia, Brazil. Arq Neuropsiquiatr 64:994–996

    Article  PubMed  Google Scholar 

  5. Meyer P, Legros C, Orliaguet G (1999) Critical care management of neurotrauma in children: new trends and perspectives. Childs Nerv Syst 15:732–739

    Article  CAS  Google Scholar 

  6. Orliaguet GA, Meyer PG, Blanot S, Jarreau MM, Charron B, Buisson C, Carli PA (1998) Predictive factors of outcome in severely traumatized children. Anesth Analg 87:537–542

    CAS  Google Scholar 

  7. Orliaguet GA, Meyer PG, Baugnon T (2008) Management of critically ill children with traumatic brain injury. Paediatr Anaesth 18:455–461

    Article  PubMed  Google Scholar 

  8. Ricard-Hibon A, Marty J (2000) Management of severe head-injured patients in the first 24 h. Resuscitation and initial diagnostic strategy. Ann Fr Anesth Rèanim 19:286–295

    PubMed  CAS  Google Scholar 

  9. Ter MA, Dube L, Guilleux AM, Wehrmann N, Ursino M, Beydon L (2002) Changes in intracranial pressure and cerebral autoregulation in patients with severe traumatic brain injury. Crit Care Med 30:1616–1622

    Article  Google Scholar 

  10. Bellner J, Romner B, Reinstrup P, Kristiansson KA, Ryding E, Brandt L (2005) Transcranial Doppler reflects intracranial pressure. Lakartidningen 102:840–841

    PubMed  Google Scholar 

  11. Meyer PG, Ducrocq S, Carli P (2001) Pediatric neurologic emergencies. Curr Opin Crit Care 7:81–87

    Article  PubMed  CAS  Google Scholar 

  12. Ng SC, Poon WS, Chan MT (2006) Cerebral hemisphere asymmetry in cerebrovascular regulation in ventilated traumatic brain injury. Acta Neurochir Suppl 96:21–23

    Article  PubMed  CAS  Google Scholar 

  13. Safin AM, Mandorskii SV, Parfenov AL, Oshorov AV (2007) Cerebral circulatory disorders in varying brain injury, as evidenced by transcranial Doppler study. Zh Vopr Neirokhir Im N N Burdenko 2:16–20

    PubMed  Google Scholar 

  14. Trabold F, Meyer PG, Blanot S, Carli PA, Orliaguet GA (2004) The prognostic value of transcranial Doppler studies in children with moderate and severe head injury. Intensive Care Med 30:108–112

    Article  PubMed  Google Scholar 

  15. Visocchi M (2008) Hyper flow and intracranial hypertension in diffuse axonal injury: an update to gennarelli doctrine. Acta Neurochir Suppl 101:137–140

    Article  PubMed  CAS  Google Scholar 

  16. Philip S, Chaiwat O, Udomphorn Y, Moore A, Zimmerman JJ, Armstead W, Vavilala MS (2009) Variation in cerebral blood flow velocity with cerebral perfusion pressure >40 mm Hg in 42 children with severe traumatic brain injury. Crit Care Med 37:2973–2978

    Article  PubMed  Google Scholar 

  17. Vavilala MS, Lee LA, Boddu K, Visco E, Newell DW, Zimmerman JJ, Lam AM (2004) Cerebral autoregulation in pediatric traumatic brain injury. Pediatr Crit Care Med 5:257–263

    Article  PubMed  Google Scholar 

  18. Meyer PG, Ducrocq S, Rackelbom T, Orliaguet G, Renier D, Carli P (2005) Surgical evacuation of acute subdural hematoma improves cerebral hemodynamics in children: a transcranial Doppler evaluation. Childs Nerv Syst 21:133–137

    Article  PubMed  Google Scholar 

  19. Udomphorn Y, Armstead WM, Vavilala MS (2008) Cerebral blood flow and autoregulation after pediatric traumatic brain injury. Pediatr Neurol 38:225–234

    Article  PubMed  Google Scholar 

  20. Trabold F, Meyer P, Orliaguet G (2002) Severe head injuries in the young child: early management. Ann Fr Anesth Rèanim 21:141–147

    PubMed  CAS  Google Scholar 

  21. Grinkeviciute DE, Kevalas R, Matukevicius A, Ragaisis V, Tamasauskas A (2008) Significance of intracranial pressure and cerebral perfusion pressure in severe pediatric traumatic brain injury. Medicina (Kaunas) 44:119–125

    Google Scholar 

  22. Nordstrom CH, Reinstrup P, Xu W, Gardenfors A, Ungerstedt U (2003) Assessment of the lower limit for cerebral perfusion pressure in severe head injuries by bedside monitoring of regional energy metabolism. Anesthesiology 98:809–814

    Article  PubMed  Google Scholar 

  23. Bardella IJ (1999) Pediatric advanced life support: a review of the AHA recommendations. American Heart Association. Am Fam Physician 60:1743–1750

    PubMed  CAS  Google Scholar 

  24. Sviri GE, Newell DW, Lewis DH, Douville C, Ghodke B, Chowdhary M, Lam AM, Haynor D, Zaaroor M, Britz GW (2006) Impact of basilar artery vasospasm on outcome in patients with severe cerebral vasospasm after aneurysmal subarachnoid hemorrhage. Stroke 37:2738–2743

    Article  PubMed  Google Scholar 

  25. Takahashi K, Hayashi S, Ootani T, Sera M, Negishi M (2008) Dural arteriovenous fistula manifesting as subarachnoid hemorrhage at the craniocervical junction. A case report. No Shinkei Geka 36:901–906

    PubMed  Google Scholar 

  26. Jesus PA, Vieira-de-Melo RM, Reis FJ, Viana LC, Lacerda A, Dias JS, Oliveira-Filho J (2006) Cognitive dysfunction in congestive heart failure: transcranial Doppler evidence of microembolic etiology. Arq Neuropsiquiatr 64:207–210

    Article  PubMed  Google Scholar 

  27. Oliveira-Filho J, Ezzeddine MA, Segal AZ, Buonanno FS, Chang Y, Ogilvy CS, Rordorf G, Schwamm LH, Koroshetz WJ, McDonald CT (2001) Fever in subarachnoid hemorrhage: relationship to vasospasm and outcome. Neurology 56:1299–1304

    PubMed  CAS  Google Scholar 

  28. Czosnyka M, Czosnyka Z, Keong N, Lavinio A, Smielewski P, Momjian S, Schmidt EA, Petrella G, Owler B, Pickard JD (2007) Pulse pressure waveform in hydrocephalus: what it is and what it isn’t. Neurosurg Focus 22:E2

    PubMed  Google Scholar 

  29. Riggo JD, Kolarovszki B, Richterova R, Kolarovszka H, Sutovsky J, Durdikc P (2007) Measurement of the blood flow velocity in the pericallosal artery of children with hydrocephalus by transcranial Doppler ultrasonography—preliminary results. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 151:285–289

    PubMed  Google Scholar 

  30. Rodriguez-Nunez A, Somoza-Martin M, Gomez-Lado C, Eiris-Punal J, Camina-Darriba F, Rodriguez-Segade S, Castro-Gago M (2008) Therapeutic criteria in communicating childhood hydrocephalus. J Neurosurg Sci 52:17–21

    PubMed  CAS  Google Scholar 

  31. Ducrocq SC, Meyer PG, Orliaguet GA, Blanot S, Laurent-Vannier A, Renier D, Carli PA (2006) Epidemiology and early predictive factors of mortality and outcome in children with traumatic severe brain injury: experience of a French pediatric trauma center. Pediatr Crit Care Med 7:461–467

    Article  PubMed  Google Scholar 

  32. Javouhey E, Guerin AC, Martin JL, Floret D, Chiron M (2009) Management of severely injured children in road accidents in France: impact of the acute care organization on the outcome. Pediatr Crit Care Med 10:472–478

    Article  PubMed  Google Scholar 

  33. Bekar A, Taskapilioglu O, Yilmazlar S, Ender K, Aksoy K (2008) Is supratentorial pressure difference clinically relevant? Analysis of 55 consecutive cases by bilateral intracranial pressure monitoring. Neurol Res 30:465–470

    Article  PubMed  Google Scholar 

  34. Bekar A, Dogan S, Abas F, Caner B, Korfali G, Kocaeli H, Yilmazlar S, Korfali E (2009) Risk factors and complications of intracranial pressure monitoring with a fiberoptic device. J Clin Neurosci 16:236–240

    Article  PubMed  CAS  Google Scholar 

  35. Chambers IR, Treadwell L, Mendelow AD (2001) Determination of threshold levels of cerebral perfusion pressure and intracranial pressure in severe head injury by using receiver-operating characteristic curves: an observational study in 291 patients. J Neurosurg 94:412–416

    Article  PubMed  CAS  Google Scholar 

  36. Chambers IR, Jones PA, Lo TY, Forsyth RJ, Fulton B, Andrews PJ, Mendelow AD, Minns RA (2006) Critical thresholds of intracranial pressure and cerebral perfusion pressure related to age in paediatric head injury. J Neurol Neurosurg Psychiatry 77:234–240

    Article  PubMed  CAS  Google Scholar 

  37. Figaji AA, Zwane E, Fieggen AG, Siesjo P, Peter JC (2009) Transcranial Doppler pulsatility index is not a reliable indicator of intracranial pressure in children with severe traumatic brain injury. Surg Neurol 72:389–394

    Article  PubMed  Google Scholar 

  38. Visocchi M, Chiaretti A, Genovese O, Di Rocco F (2007) Haemodynamic patterns in children with posttraumatic diffuse brain swelling. A preliminary study in 6 cases with neuroradiological features consistent with diffuse axonal injury. Acta Neurochir (Wien) 149:347–356

    Article  CAS  Google Scholar 

  39. Murillo-Cabezas F, Arteta-Arteta D, Flores-Cordero JM, Munoz-Sanchez MA, Rincon-Ferrari MD, Rivera-Fernandez MV, Alacron-Cruz JC (2002) The usefulness of transcranial Doppler ultrasonography in the early phase of head injury. Neurocirugia (Astur) 13:196–208

    CAS  Google Scholar 

  40. Muttaqin Z, Uozumi T, Kuwabara S, Arita K, Kurisu K, Ohba S, Kohno Ogasawara H, Ohtani M, Mikami T (1993) Hyperaemia prior to acute cerebral swelling in severe head injuries: the role of transcranial Doppler monitoring. Acta Neurochir (Wien) 123:76–81

    Article  CAS  Google Scholar 

  41. Hindy-Francois C, Orliaguet G, Meyer P, Carli P, Blanot S, Hertz-Pannier L, Brunelle F (2009) Pediatric brain death diagnosis in the view of organ donation in France. Transplantation 87:616–617

    Article  PubMed  Google Scholar 

Download references

Acknowledgement

CAPES-Brazil (Coordenação de Aperfeiçoamento de Pessoal de Nível Superior) funded Jose Roberto Tude Melo’s studies abroad.

Conflict of Interest

None.

Author information

Authors and Affiliations

  1. Department of Pediatric Neurosurgery Hôpital Necker-Enfants Malades (Assistance Publique Hôpitaux de Paris, France), Université Descartes Paris 5, Paris, France

    José Roberto Tude Melo, Federico Di Rocco, Christian Sainte-Rose & Michel Zerah

  2. School of Medicine, Federal University of Bahia, Bahia, Brazil

    José Roberto Tude Melo & Jamary Oliveira-Filho

  3. Pediatric Surgical Critical Care Unit, and Anesthesiology, Hôpital Necker-Enfants Malades (Assistance Publique Hôpitaux de Paris, France), Université Descartes Paris 5, Paris, France

    Stéphane Blanot, Harry Cuttaree & Philippe G. Meyer

  4. Alameda dos Jasmins No. 200 Apt. 702B, Cidade Jardim, Salvador, Bahia, 40296200, Brazil

    José Roberto Tude Melo

Authors
  1. José Roberto Tude Melo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Federico Di Rocco
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Stéphane Blanot
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Harry Cuttaree
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Christian Sainte-Rose
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jamary Oliveira-Filho
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Michel Zerah
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Philippe G. Meyer
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to José Roberto Tude Melo.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Melo, J.R.T., Di Rocco, F., Blanot, S. et al. Transcranial Doppler can predict intracranial hypertension in children with severe traumatic brain injuries. Childs Nerv Syst 27, 979–984 (2011). https://doi.org/10.1007/s00381-010-1367-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00381-010-1367-8

Keywords

Search

Navigation