Is The Combination of Glasgow Coma Scale and Transcranial Doppler Pulsatility Index Improving The Prediction of Outcome in Traumatic Brain Injury Patients?

Abstract

Background: Glasgow coma scale (GCS) is a familiar scoring system with a standard statistical association with neurological outcome, it has many limitations that minimize its ability in prediction of Traumatic brain injury (TBI) patients' outcome. Transcranial Doppler (TCD) is a noninvasive aid in this field that can improve outcome prediction. Objective: This study aims to explore the effect of combination of GCS and Pulsatility Index (PI) in the prediction of outcome of TBI patients. Patients and Method: This study was performed in Zagazig University Hospital (ZUH). 103 traumatic brain injured patients were engaged in the investigations with hospital days of 1, 2, 3, and 7 or until patient discharge. The study was performed by TCD along with GCS recordings. Prognosis was also assessed by the Glasgow outcome scale (GOS). Results: The sensitivity and negative predictive value of PI was more than GCS in TBI patients (GCS 3-15), as they were (67.5% versus 50%) and (81.1% versus 74.3%), respectively. The combination of both PI and GCS increased the sensitivity and the negative predictive value up to 70% and 83.3%, respectively. PI had higher sensitivity, positive and negative predictive values than GCS in the identification of secondary neurologic deterioration (SND) in mild and moderate TBI patients (73.3% versus 40.0%, 61.1% versus 50.0%, and 92.0% versus 83.9%, respectively), while the combined value of both PI and GCS increased both sensitivity and positive predictive value up to 76.7% and 66.7%, respectively. Conclusion: The combination of GCS and PI would improve the prediction of outcome.

Verification of Sphenopalatine Ganglion Block Success Using Transcranial Doppler in Management of Patients with Postdural

“…Using transcranial Doppler (TCD) to analyze the pulsatile cerebral blood flow velocity (CBFV) waveform of the intracranial arteries can provide information regarding various cerebrovascular changes (8). There have been great advances in TCD applications, as it was initially used for detecting vasospasm in subarachnoid hemorrhage and in brain stem death; more recently it has been used to predict the outcomes of patients with traumatic brain injury (9). The cerebral blood flow resistance can be measured by pulsatility index (PI) (10).…”