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The accuracy of transcranial Doppler to detect vasospasm in patients with aneurysmal subarachnoid hemorrhage

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Abstract

Objectives

To examine the accuracy of transcranial Doppler to detect cerebral vasospasm in a patient population with aneurysmal subarachnoid hemorrhage.

Design

Prospective blind comparison of transcranial Doppler with cerebral angiography. Diagnostic accuracy of transcranial Doppler was assessed using receiver operating characteristic (ROC) analysis and likelihood ratios. Sensitivity and specificity were calculated using directly measured middle cerebral artery diameter as reference standard.

Setting

Intensive Care Unit of a large university teaching hospital.

Patients and participants

Twenty-two patients with subarachnoid hemorrhage were included. Patients underwent angiography on admission and after 8 days to diagnose vasospasm and were defined as having clinical vasospasm, angiographic vasospasm, or no vasospasm.

Measurements and results

Sensitivity and specificity were 1.00 and 0.75 for angiographic vasospasm and both equal to 1.00 for clinical vasospasm diagnosis. A transcranial Doppler mean velocity threshold value of 100 cm/s for angiographic vasospasm and 160 cm/s for clinical vasospasm detection were chosen by ROC analysis.

Conclusions

A Transcranial Doppler mean velocity threshold of 160 cm/s, calculated by the ROC analysis, accurately detects clinical vasospasm. A daily transcranial Doppler examination performed by a trained operator should be routinely used to provide early identification of patients at high risk and to orient therapeutic decisions.

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Acknowledgments

The authors thank DWL, Elektronische Systeme, Supplingen, Germany for kindly supplying the Doppler equipment, and Foundation Baxter and Alma Ricard Chair in cerebrovascular surgery, University of Toronto for supporting the study.

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Authors and Affiliations

  1. Dipartimento di Discipline Medico-Chirurgiche, Sezione di Anestesiologia e Rianimazione, Ospedale S. Giovanni Battista, Università di Torino, Corso Dogliotti 14, 10126, Torino, Italy

    L. Mascia & V. M. Ranieri

  2. Department of Anaesthesia, Toronto General Hospital, University of Toronto, Toronto, Canada

    L. Fedorko

  3. Division of Neuroradiology, Toronto Western Hospital, University of Toronto, Toronto, Canada

    K. terBrugge

  4. Dipartimento di Discipline Medico-Chirurgiche, Servizio Informatico, Ospedale S. Giovanni Battista, Università di Torino, Torino, Italy

    C. Filippini & M. Pizzio

  5. Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Canada

    M. C. Wallace

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  1. L. Mascia
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  2. L. Fedorko
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  3. K. terBrugge
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  4. C. Filippini
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  5. M. Pizzio
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  6. V. M. Ranieri
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  7. M. C. Wallace
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Corresponding author

Correspondence to L. Mascia.

Additional information

Dr L. Mascia was supported by the PhD program in Applied Physiology, University of Turin, Italy.

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Mascia, L., Fedorko, L., terBrugge, K. et al. The accuracy of transcranial Doppler to detect vasospasm in patients with aneurysmal subarachnoid hemorrhage. Intensive Care Med 29, 1088–1094 (2003). https://doi.org/10.1007/s00134-003-1780-5

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  • DOI: https://doi.org/10.1007/s00134-003-1780-5

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