Le doppler transcrânien aux urgences chez le traumatisé crânien

The vast majority of patients with traumatic brain injury (TBI) are those admitted to the emergency room for mild (Glasgow coma scale score 14-15) or moderate (Glasgow coma scale score 9-13) brain trauma. These patients are, however, at risk for secondary neurological deterioration. Although computed tomography (CT) is the reference technique to identify intra- and extracerebral lesions in those TBI patients, it may lack of performance to detect which patients are at risk for secondary neurological deterioration. Transcranial doppler (TCD) is a noninvasive method that records cerebral blood flow velocity of major brain arteries and provides useful information on cerebral haemodynamics. Cerebral hypoperfusion results in low diastolic velocity (FV_d) and in increased pulsatility index (PI) in severe TBI. Those signs can be seen on admission at the emergency room even in patients with normal or minor CT findings, and are associated with secondary neurological deterioration. Therefore, the use of TCD at the emergency room could be of value in detecting high-risk patients with mild and moderate TBI to optimize their monitoring and treatment, in association with clinical and CT examination.