Saudi journal of anaesthesia
July 2, 2026 · via Europe PMC
Role of transcranial Doppler pulsatility index for predicting neurological deterioration in mild-to-moderate traumatic brain injury patients in intensive care unit.
Kaur S, Rani N.
AI summary — for doctors, generated from the abstract only
In a prospective study of 100 patients with mild-to-moderate traumatic brain injury, a higher transcranial Doppler pulsatility index at admission was significantly associated with subsequent neurological deterioration, suggesting this noninvasive bedside measurement could help identify at-risk patients earlier.
What was studied
A prospective observational study of 100 adult patients with mild-to-moderate traumatic brain injury admitted to a tertiary ICU, measuring transcranial Doppler (TCD) middle cerebral artery pulsatility index (PI) at admission and following patients for 7 days to assess its value in predicting neurological deterioration (defined as a Glasgow Coma Scale drop of 2 or more points, need for mechanical ventilation, or need for neurosurgical intervention), using ROC analysis and multivariate logistic regression.
Key findings
- Neurological deterioration occurred in 22% of the 100 patients.
- Admission pulsatility index was significantly higher in patients who later deteriorated compared with those who remained stable (1.35 vs 1.14).
- The study concluded, via ROC and multivariate analysis, that admission PI was a reliable predictor of early neurological deterioration, though the exact AUC, sensitivity, and specificity values were not fully detailed in the provided abstract text.
Clinical relevance
This may be relevant to ICU clinicians managing patients with mild-to-moderate traumatic brain injury, suggesting that a simple, noninvasive bedside transcranial Doppler measurement at admission could help identify patients at higher risk of deterioration, supporting earlier and more targeted monitoring or intervention.
Who should care
Limitations
This was a single-center, observational study with a modest sample size (100 patients), and while statistically significant, the exact magnitude of predictive accuracy (AUC, sensitivity, specificity) was not fully available in the provided abstract text, limiting precise assessment of its clinical discriminative power.
A noninvasive ultrasound measure of brain blood flow resistance (pulsatility index) taken at admission helped predict which mild-to-moderate TBI patients would later deteriorate neurologically.
This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.
Abstract
Background
Traumatic brain injury (TBI) is a leading cause of death and long-term disability worldwide, particularly among young adults in low- and middle-income countries. Even patients presenting with mild-to-moderate TBI may experience secondary neurological deterioration due to evolving intracranial pathology. Early identification of patients at risk remains challenging. Transcranial Doppler (TCD) ultrasonography provides a noninvasive bedside assessment of cerebral hemodynamics, and the pulsatility index (PI) reflects downstream cerebrovascular resistance and intracranial compliance.
Methods
This prospective observational study included 100 adult patients with mild-to-moderate TBI admitted to a tertiary care intensive care unit (ICU). Demographic data, mechanism of injury, clinical status, and computed tomography (CT) findings were recorded. TCD examination was performed at admission to measure middle cerebral artery velocities and calculate PI. Patients were followed for seven days. Neurological deterioration was defined as a decrease in Glasgow Coma Scale score by ≥2 points, requirement of mechanical ventilation, or need for neurosurgical intervention. Receiver operating characteristic (ROC) curve analysis and multivariate logistic regression were used to assess the predictive value of PI.
Results
Neurological deterioration occurred in 22% of patients. Admission PI was significantly higher in patients who deteriorated compared with those who remained stable (1.35 ± 0.18 vs. 1.14 ± 0.17; P < 0.001). ROC analysis demonstrated that PI predicted neurological deterioration with an area under the curve of 0.82 (95% confidence interval (CI): 0.73-0.91). A PI cutoff value of ≥1.25 yielded a sensitivity of 77% and a specificity of 80%. On multivariate analysis, admission PI ≥1.25 independently predicted neurological deterioration (adjusted OR 4.3; 95% CI 1.7-10.8).
Conclusion
Admission PI measured by TCD is a reliable, noninvasive predictor of early neurological deterioration in patients with mild-to-moderate TBI and may aid early risk stratification in the ICU.
DOI
10.4103/sja.sja_824_25
PMID
42553827
PMCID
PMC13436879
Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.
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