Noninvasive screening for intracranial hypertension in children with acute, severe traumatic brain injury.

Journal Article (Journal Article)


The aim of this study was to determine the relationship between transcranial Doppler (TCD) derived pulsatility index (PI), end diastolic flow velocity (Vd), and intracranial pressure (ICP). The subjects in this study were 36 children admitted after severe traumatic brain injury (TBI) (postresuscitation Glasgow Coma Scale ≤ 8) undergoing invasive ICP monitoring.


Subjects underwent a total of 148 TCD studies. TCD measurements of systolic flow velocity (Vs), Vd, and mean flow velocity (Vm) were performed on the middle cerebral artery (MCA) ipsilateral to the ICP monitor. The PI was calculated by the TCD software (Vs-Vd/Vm). ICP registrations were made in parallel with TCD measurements.


Using a PI threshold of 1.3, postinjury Day 0-1 PI had 100% sensitivity and 82% specificity at predicting an ICP ≥ 20 mm Hg (n = 8). During this time frame, a moderately strong relationship was observed between the MCA PI and actual ICP (r = 0.611, p = 0.01). When using a threshold of < 25 cm/sec, postinjury Day 0-1 Vd had a 56% sensitivity to predict an ICP ≥ 20 mm Hg. Beyond the initial 24 hours from injury, the sensitivity of an MCA PI of 1.3 to detect an ICP ≥ 20 mm Hg was 47%, and a weak relationship between actual ICP values and MCA PI (r = 0.376, p = 0.01) and MCA Vd (r = -0.284, p = 0.01) was found.


Postinjury Day 0-1 MCA PI > 1.3 has good sensitivity and specificity at predicting an ICP ≥ 20 mm Hg. In those children with TBI who initially do not meet clear criteria for invasive ICP monitoring but who are at risk for development of intracranial hypertension, TCD may be used as a noninvasive tool to screen for the development of elevated ICP in the first 24 hours following injury.

Full Text

Duke Authors

Cited Authors

  • O'Brien, NF; Maa, T; Reuter-Rice, K

Published Date

  • October 2015

Published In

Volume / Issue

  • 16 / 4

Start / End Page

  • 420 - 425

PubMed ID

  • 26140576

Electronic International Standard Serial Number (EISSN)

  • 1933-0715

International Standard Serial Number (ISSN)

  • 1933-0707

Digital Object Identifier (DOI)

  • 10.3171/2015.3.peds14521


  • eng