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

  • Neonatal and Pediatric Intensive Care
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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.

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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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Authors and Affiliations

  1. Department of Anesthesiology and Critical Care, Hôpital de Bicêtre, Le Kremlin Bicêtre, Assistance Publique-Hôpitaux de Paris, Université Paris XI, 63 rue Gabriel Péri, 94276, Le Kremlin-Bicêtre, France

    Fabien Trabold

  2. Department of Anesthesiology and Critical Care, Hôpital Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université Paris V, 149 rue de Sèvres, 75743, Paris Cedex 15, France

    Philippe G. Meyer, Stéphane Blanot, Pierre A. Carli & Gilles A. Orliaguet

Authors
  1. Fabien Trabold
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  2. Philippe G. Meyer
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  3. Stéphane Blanot
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  4. Pierre A. Carli
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  5. Gilles A. Orliaguet
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Corresponding author

Correspondence to Gilles A. Orliaguet.

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Trabold, F., Meyer, P.G., Blanot, S. et al. The prognostic value of transcranial Doppler studies in children with moderate and severe head injury. Intensive Care Med 30, 108–112 (2004). https://doi.org/10.1007/s00134-003-2057-8

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  • DOI: https://doi.org/10.1007/s00134-003-2057-8

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