Melo José Roberto Tude, Di Rocco Federico, Blanot Stéphane, Cuttaree Harry, Sainte-Rose Christian, Oliveira-Filho Jamary, Zerah Michel, Meyer Philippe G
Department of Pediatric Neurosurgery, Hôpital Necker-Enfants Malades (Assistance Publique Hôpitaux de Paris, France), Université Descartes Paris 5, Paris, France.
Childs Nerv Syst. 2011 Jun;27(6):979-84. doi: 10.1007/s00381-010-1367-8. Epub 2011 Jan 5.
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).
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.
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%.
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.
本研究旨在评估急诊经颅多普勒（TCD）预测重型颅脑损伤（TBI）患儿颅内高压和异常脑灌注压的准确性。
通过收集2000年1月至2005年12月期间入住一级儿科创伤中心的重型TBI患儿（格拉斯哥昏迷量表≤8分）的病历数据，设计了一项描述性回顾性横断面研究。入院时进行早期TCD检查，使用先前验证的舒张期速度（<25 cm/s）和搏动指数（>1.31）阈值，或在检测到无血流/逆流时，将TCD频谱视为改变。有创颅内压（ICP）和脑灌注压（CPP）监测被视为测量颅内高压（ICH）的金标准。统计分析比较了入院时TCD频谱与升高的ICP（≥20 mmHg）和异常脑灌注压（<50 mmHg）。
对117例重型颅脑损伤患儿进行了无创TCD和ICP监测。平均年龄为7.6±4.4岁，男性占多数（71%）。初始格拉斯哥昏迷量表中位数为6分。TCD在入院时识别ICH的敏感性为94%，识别入院时正常ICP的阴性预测值为95%。其预测异常脑灌注压的敏感性为80%。
入院时TCD对预测创伤后ICH和异常CPP具有高敏感性，表明TCD是确定那些需要紧急积极治疗和持续有创ICP监测患儿的优秀一线检查方法。
