Transcranial color‐code sonography non‐invasive assessment of intracranial pressure after decompressive craniectomy in patients with acute severe traumatic brain injury / 中华超声影像学杂志

ABSTRACT

To evaluate the accuracy of transcranial color‐code sonography ( TCCS) in non‐invasive assessment of intracranial pressure( ICP ) . TCCS was used to monitor the cerebral hemodynamic parameters of patients with acute severe traumatic brain injury after decompressive craniectomy and make estimation of the non‐invasive intracranial pressure ( ICPtccs) . Methods A total of 91 patients with acute severe traumatic brain injury involved in this retrospective study were divided into the ICP normal group( ≤22 mm Hg ) and the ICP increased group ( ＞22 mm Hg ) . T he correlation and consistency of middle cerebral artery blood flow parameters and ICPtccs with invasive intracranial pressure ( iICP ) were analyzed . According to Glasgow score ( GCS) ,Patients( GCS 3－8) were divided into acute extremely severe traumatic brain injury( GCS 3 －5) and acute severe traumatic brain injury ( GCS 6 －8 ) . A comparison was made of ROC ( ICPtccs) curve and the area under the curve( AUC) between the two groups were cornpared . Results①No statistical differences were found in cerebral hemodynamic parameters between the side with and without decompressive craniectomy in patients with acute severe traumatic brain injury ( all P ＞0 .05 ) . ②M onitored resistive index ( RI) ,pulsatility index ( PI) and ICPtccs between the normal ICP group and the increased ICP group showed statistically significant differences ( all P ＜ 0 .05 ) ,w hile monitored systolic velocity ,diastolic velocity and mean velocity presented no statistically significant difference ( all P ＞0 .05) . T he correlations between RI ,PI with iICP were low ( r＝ 0 .247 ,0 .221 ; all P ＜ 0 .05 ) ,w hile there was a moderate correlation between ICPtccs and iICP( r ＝0 .417 , P ＜0 .001 ) . ③Bland‐Altman plot showed an overestimation of 2 .3 mm Hg ( 95% CI 0 .00－4 .59 mm Hg ) for ICPtccs compared to iICP . ④T he AUC of Glasgow score ( GCS 3－5 and GCS 6－8) in the two groups were 0 .759 ,0 .781 ( all P ＜0 .05) . All the cut‐off points of ICPtccs were 19 mm Hg ,with a sensitivity of 83 .33% ,81 .82% and a specificity of 64 .86% , 75 .68% ,respectively . Pairwise comparison of two AUCs showed no statistical difference ( P ＝ 0 .476) . ICPtccs presented the same ability to estimate ICP in patients with acute severe and extremely severe traumatic brain injury . TCCS could accurately assess the elevation of ICP in 72 .52% patients with acute severe traumatic brain injury . Conclusions TCCS can be used as a non‐invasive screening tool to assess w hether ICP of patients with acute severe traumatic brain injury is elevated and to semi‐quantitatively estimate ICP ,showing useful clinical value .