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

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.