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

Publication ,  Journal Article
O'Brien, NF; Maa, T; Reuter-Rice, K
Published in: Journal of neurosurgery. Pediatrics
October 2015

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.

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Published In

Journal of neurosurgery. Pediatrics

DOI

EISSN

1933-0715

ISSN

1933-0707

Publication Date

October 2015

Volume

16

Issue

4

Start / End Page

420 / 425

Related Subject Headings

  • Ultrasonography, Doppler, Transcranial
  • Sensitivity and Specificity
  • Rheology
  • Pulsatile Flow
  • Prospective Studies
  • Predictive Value of Tests
  • Neurology & Neurosurgery
  • Monitoring, Physiologic
  • Middle Cerebral Artery
  • Male
 

Citation

APA
Chicago
ICMJE
MLA
NLM
O’Brien, N. F., Maa, T., & Reuter-Rice, K. (2015). Noninvasive screening for intracranial hypertension in children with acute, severe traumatic brain injury. Journal of Neurosurgery. Pediatrics, 16(4), 420–425. https://doi.org/10.3171/2015.3.peds14521
O’Brien, Nicole F., Tensing Maa, and Karin Reuter-Rice. “Noninvasive screening for intracranial hypertension in children with acute, severe traumatic brain injury.Journal of Neurosurgery. Pediatrics 16, no. 4 (October 2015): 420–25. https://doi.org/10.3171/2015.3.peds14521.
O’Brien NF, Maa T, Reuter-Rice K. Noninvasive screening for intracranial hypertension in children with acute, severe traumatic brain injury. Journal of neurosurgery Pediatrics. 2015 Oct;16(4):420–5.
O’Brien, Nicole F., et al. “Noninvasive screening for intracranial hypertension in children with acute, severe traumatic brain injury.Journal of Neurosurgery. Pediatrics, vol. 16, no. 4, Oct. 2015, pp. 420–25. Epmc, doi:10.3171/2015.3.peds14521.
O’Brien NF, Maa T, Reuter-Rice K. Noninvasive screening for intracranial hypertension in children with acute, severe traumatic brain injury. Journal of neurosurgery Pediatrics. 2015 Oct;16(4):420–425.

Published In

Journal of neurosurgery. Pediatrics

DOI

EISSN

1933-0715

ISSN

1933-0707

Publication Date

October 2015

Volume

16

Issue

4

Start / End Page

420 / 425

Related Subject Headings

  • Ultrasonography, Doppler, Transcranial
  • Sensitivity and Specificity
  • Rheology
  • Pulsatile Flow
  • Prospective Studies
  • Predictive Value of Tests
  • Neurology & Neurosurgery
  • Monitoring, Physiologic
  • Middle Cerebral Artery
  • Male