Monitoring midline shift by transcranial color-coded sonography in traumatic brain injury

Pou, J.A. Llompart; Centellas, J. M. Abadal; Sans, Margarita Palmer; Bárcena, Jon Pérez; Vivas, Marcial Casares; Ramírez, Javier Homar; Juve, J. Ibanez

doi:10.1007/s00134-004-2348-8

Cited by 47 publications

(14 citation statements)

References 7 publications

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“…Midline shift (MLS) measurement is performed using the third ventricle, a structure visualized from the transtemporal view in a diencephalic plane . Similar agreement has been observed between TCCS and cranial CT scan for this purpose . The midline shift is obtained with the formula (A

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Section: Potential Indications For a Tccs In The Emergency Departmentsupporting

confidence: 67%

“…The midline shift is obtained with the formula (A

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B)/2, in which “A” is acquired from the start of the ultrasound beam to the center of the third ventricle in one side, and “B” with the same procedure performed from the contralateral‐side insonation (Figure ). A midline shift cutoff of 2.5 mm or greater showed sensitivity of 0.78, specificity of 0.89, positive predictive value of 0.86, negative predictive value of 0.83, and accuracy of 0.82 in predicting large intracerebral hemorrhage …”

Section: Potential Indications For a Tccs In The Emergency Departmentmentioning

confidence: 99%

“…In some circumstances, such as bone defects (eg, decompressive craniectomy or skull fractures), temporal cephallohematomas or alterations in intracranial anatomy secondary to trauma, using the aforementioned method of midline shift measurement, may be imprecise …”

Section: Potential Indications For a Tccs In The Emergency Departmentmentioning

confidence: 99%

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Applications of Transcranial Color-Coded Sonography in the Emergency Department

Blanco

Blaivas

2017

J Ultrasound Med

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Transcranial color-coded Doppler sonography is a noninvasive bedside ultrasound application that combines both imaging of parenchymal structures and Doppler assessment of intracranial vessels. It may aid in rapid diagnoses and treatment decision making of patients with intracranial emergencies in point-of-care settings. This pictorial essay illustrates the technical aspects and emergency department applications of transcranial color-coded Doppler sonography, and provides some rationale for implementation of this technique into the emergency department practice.

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Section: Potential Indications For a Tccs In The Emergency Departmentsupporting

confidence: 67%

“…The midline shift is obtained with the formula (A

-

Section: Potential Indications For a Tccs In The Emergency Departmentmentioning

confidence: 99%

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Applications of Transcranial Color-Coded Sonography in the Emergency Department

Blanco

Blaivas

2017

J Ultrasound Med

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“…This seemed to correlate well with findings on CT [ 24 - 27 ] and to be able to serve as an early outcome predictor by rapidly detecting a significant MLS in acute stroke [ 28 , 29 ]. However, this was described only in one small study of patients with TBI [ 30 ].…”

Section: Introductionmentioning

confidence: 99%

Assessment of brain midline shift using sonography in neurosurgical ICU patients

et al. 2014

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IntroductionBrain midline shift (MLS) is a life-threatening condition that requires urgent diagnosis and treatment. We aimed to validate bedside assessment of MLS with Transcranial Sonography (TCS) in neurosurgical ICU patients by comparing it to CT.MethodsIn this prospective single centre study, patients who underwent a head CT were included and a concomitant TCS performed. TCS MLS was determined by measuring the difference between the distance from skull to the third ventricle on both sides, using a 2 to 4 MHz probe through the temporal window. CT MLS was measured as the difference between the ideal midline and the septum pellucidum. A significant MLS was defined on head CT as >0.5 cm.ResultsA total of 52 neurosurgical ICU patients were included. The MLS (mean ± SD) was 0.32 ± 0.36 cm using TCS and 0.47 ± 0.67 cm using CT. The Pearson’s correlation coefficient (r2) between TCS and CT scan was 0.65 (P <0.001). The bias was 0.09 cm and the limits of agreements were 1.10 and -0.92 cm. The area under the ROC curve for detecting a significant MLS with TCS was 0.86 (95% CI =0.74 to 0.94), and, using 0.35 cm as a cut-off, the sensitivity was 84.2%, the specificity 84.8% and the positive likelihood ratio was 5.56.ConclusionsThis study suggests that TCS could detect MLS with reasonable accuracy in neurosurgical ICU patients and that it could serve as a bedside tool to facilitate early diagnosis and treatment for patients with a significant intracranial mass effect.

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“…Reportar la medición en milímetros y si la desviación es hacia la izquierda o derecha. 21,22 Diseño estadístico: El análisis se hizo con la prueba estadística de correlación de Pearson, se utilizó el software computacional SPSS para la realización y descripción gráfi ca.…”

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Correlación de la desviación de la línea media por ultrasonido transcraneal y tomografía axial computarizada

et al. 2018

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Results: A mean of 6.81 mm of mean deviation of the cerebral midline was obtained for patients who were measured by ultrasound technique and mean of 6.63 mm for patients measured by computerized axial computed tomography. It was correlated by Pearson obtaining a correlation of 0.774 (95% CI) which is signifi cant. Discussion: We propose the measurement of the deviation of the cerebral midline by transcranial ultrasound as a rapid method, at the head of the patient, which generates few costs and can replace the lack of a CT. It can be included as a quick measure to decide on surgical management if there is mass effect, hypertensive skull or neurological targeting and we do not have available tomography. The implication contrary to this meaning is that there must be a previous training of the personnel for the realization of transcranial ultrasound since it is a «dependent» operator. Conclusion: The measurement of the midline by ultrasound and cranial tomography are signifi cantly correlated, so the use of transcranial ultrasound can be an instrument of assessment in case of not having a tomograph, although a larger number is required of studies to be conclusive.

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Monitoring midline shift by transcranial color-coded sonography in traumatic brain injury

Cited by 47 publications

References 7 publications

Applications of Transcranial Color-Coded Sonography in the Emergency Department

Applications of Transcranial Color-Coded Sonography in the Emergency Department

Assessment of brain midline shift using sonography in neurosurgical ICU patients

Correlación de la desviación de la línea media por ultrasonido transcraneal y tomografía axial computarizada

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