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dc.contributor.authorZeiler, Frederick A
dc.contributor.authorCardim, Danilo
dc.contributor.authorDonnelly, Joseph
dc.contributor.authorMenon, David K
dc.contributor.authorCzosnyka, Marek
dc.contributor.authorSmielewski, Peter
dc.date.accessioned2018-01-19T11:35:53Z
dc.date.available2018-01-19T11:35:53Z
dc.date.issued2018-01-15
dc.identifier.issn0897-7151
dc.identifier.urihttps://www.repository.cam.ac.uk/handle/1810/270829
dc.description.abstractThe purpose of our study was to explore relationships between transcranial Doppler (TCD) indices of cerebrovascular reactivity and those derived from intracranial pressure (ICP). Goals included: A) confirming previously described co-variance patterns of TCD/ICP indices, and B) describing thresholds for systolic flow index (Sx; correlation between systolic flow velocity [FVs] and cerebral perfusion pressure [CPP]) associated with outcome. In a retrospective cohort of traumatic brain injury (TBI) patients: with TCD and ICP monitoring, we calculated various continuous indices of cerebrovascular reactivity: A) ICP (pressure reactivity index [PRx]: correlation between ICP and mean arterial pressure [MAP]; PAx: correlation between pulse amplitude of ICP [AMP] and MAP; RAC: correlation between AMP and CPP) and B) TCD (mean flow index [Mx]: correlation between mean flow velocity [FVm] and CPP; Mx_a: correlation between FVm and MAP; Sx: correlation between FVs and CPP; Sx_a: correlation between FVs and MAP; Dx: correlation between diastolic flow velocity [FVd] and CPP; Dx_a: correlation between FVd and MAP). We assessed the relationships via various statistical techniques, including: principal component analysis, agglomerative hierarchal clustering, and k-means cluster analysis (KMCA). We performed sequential χ2 testing to define thresholds associated with outcome for Sx/Sx_a. Outcome was assessed at 6 months via dichotomized Glasgow Outcome Score (GOS): A) Favorable (GOS 4 or 5) versus Unfavorable (GOS 3 or less), B) Alive versus Dead. We analyzed 410 recordings in 347 patients. All analyses confirmed our previously described co-variance of Sx/Sx_a with ICP-derived indices. Sx displayed thresholds of -0.15 for unfavorable outcome (p < 0.0001) and -0.20 for mortality (p < 0.0001). Sx_a displayed thresholds of +0.05 (p = 0.019) and -0.10 (p = 0.0001) for alive/dead and favorable/unfavorable outcomes. TCD systolic indices are most closely associated with ICP indices. Sx and Sx_a likely provide better approximation of ICP indices, compared with Mx/Mx_a/Dx/Dx_a. Sx provides superior outcome prediction, versus Mx, with defined thresholds.
dc.format.mediumPrint-Electronic
dc.languageeng
dc.publisherMary Ann Liebert Inc
dc.subjectHumans
dc.subjectUltrasonography, Doppler, Transcranial
dc.subjectRetrospective Studies
dc.subjectCohort Studies
dc.subjectCerebrovascular Circulation
dc.subjectIntracranial Pressure
dc.subjectAdult
dc.subjectMiddle Aged
dc.subjectFemale
dc.subjectMale
dc.subjectYoung Adult
dc.subjectArterial Pressure
dc.subjectBrain Injuries, Traumatic
dc.titleTranscranial Doppler Systolic Flow Index and ICP-Derived Cerebrovascular Reactivity Indices in Traumatic Brain Injury.
dc.typeArticle
prism.endingPage322
prism.issueIdentifier2
prism.publicationDate2018
prism.publicationNameJ Neurotrauma
prism.startingPage314
prism.volume35
dc.identifier.doi10.17863/CAM.17755
dcterms.dateAccepted2017-09-27
rioxxterms.versionofrecord10.1089/neu.2017.5364
rioxxterms.versionAM
rioxxterms.licenseref.urihttp://www.rioxx.net/licenses/all-rights-reserved
rioxxterms.licenseref.startdate2018-01
dc.contributor.orcidZeiler, Frederick [0000-0003-1737-0510]
dc.contributor.orcidCardim, Danilo [0000-0002-9261-1321]
dc.contributor.orcidDonnelly, Joseph [0000-0002-6502-8069]
dc.contributor.orcidMenon, David [0000-0002-3228-9692]
dc.contributor.orcidCzosnyka, Marek [0000-0003-2446-8006]
dc.contributor.orcidSmielewski, Peter [0000-0001-5096-3938]
dc.identifier.eissn1557-9042
rioxxterms.typeJournal Article/Review
pubs.funder-project-idMedical Research Council (G0600986)
cam.issuedOnline2017-12-18
rioxxterms.freetoread.startdate2018-12-18


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