Value of pulsatility index of internal carotid artery and middle cerebral artery in predicting intracranial pressure of patients with severe traumatic brain injury
Objective To assess the predictive value of pulsatility index(PI)of internal carotid artery(ICA)and middle cerebral artery(MCA)in intracranial pressure assessment of patients with severe traumatic brain injury(sTBI).Methods A retrospective case series study was conducted to analyze the clinical data of 104 sTBI patients who were admitted to 904th Hospital of Joint Logistic Support Force of PLA from January 2021 to August 2023,including 73 males and 31 females,aged 16-77 years[(56.4±15.9)years].The Glasgow Coma Scale(GCS)scores were 3-8 points[(6.1±1.6)points].A total of 176 detections of mean blood flow velocity(Vm)and PI of ICA and MCA by transcranial Doppler(TCD)ultrasonography after invasive intracranial pressure monitoring as well as hemodynamic parameters such as systolic blood pressure(SBP),diastolic blood pressure(DBP)and heart rate(HR)were collected.The patients were divided into normal intracranial pressure group(intracranial pressure ≤20 mmHg,126 detections)and intracranial hypertension group(intracranial pressure＞20 mmHg,50 detections)according to the 176 detections obtained by invasive intracranial pressure monitoring.The Vm and PI of ICA and MCA and the hemodynamic parameters were compared between the two groups.Pearson correlation analysis was used to assess the correlation between PI of ICA and MCA and invasive intracranial pressure and linear regression analysis was conducted.The Bland-Altman difference analysis was applied to assess the consistency between intracranial pressure predicted by PI of ICA and MCA and invasive intracranial pressure.The receiver operating characteristic(ROC)curve was plotted to analyze the capacity of PI of ICA and MCA in predicting intracranial hypertension and the area under the curve(AUC),95％CI,sensitivity and specificity were calculated.Results In the intracranial hypertension group,the PI values of ICA and MCA were 1.21±0.24 and 1.22± 0.25 respectively,which were significantly higher than those in the normal intracranial pressure group(1.12±0.15 and 1.13±0.20 respectively)(P＜0.05 or 0.01).There were no significant differences in the Vm vaules of ICA and MCA,SBP,DBP or HR between the two groups(P＞0.05).Pearson correlation analysis showed that PI of ICA and MCA was significantly correlated with invasive intracranial pressure(r=0.29,P＜0.01;r=0.31,P＜0.01).Bland-Altman analysis showed that the mean deviations of PI of ICA and MCA in predicting intracranial pressure were+0.08 mmHg and+0.16 mmHg respectively(P＞0.05).The ROC curve showed that AUC values of PI of ICA and MCA in predicting intracranial hypertension were 0.61(95％CI 0.52,0.70)and 0.60(95％CI 0.51,0.70),with the sensitivity of 58％and 50％as well as the specificity of 60％and 74％respectively,and there was no significant difference in AUC between the PI of ICA and MCA(P＞0.05).Conclusion The predictive performance of PI of ICA and MCA by TCD in assisting dynamic assessment of intracranial pressure and diagnosis of intracranial hypertension in sTBI patients is similar,but the preditive accuracy and stability of both remain to be improved.
Brain injuriesTranscranial Doppler ultrasonographyIntracranial hypertensionPulsatility index
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