Assessment of brain midline shift using sonography in neurosurgical ICU patients.
Crit Care
; 18(6): 676, 2014 Dec 09.
Article
em En
| MEDLINE
| ID: mdl-25488604
ABSTRACT
INTRODUCTION:
Brain midline shift (MLS) is a life-threatening condition that requires urgent diagnosis and treatment. We aimed to validate bedside assessment of MLS with Transcranial Sonography (TCS) in neurosurgical ICU patients by comparing it to CT.METHODS:
In this prospective single centre study, patients who underwent a head CT were included and a concomitant TCS performed. TCS MLS was determined by measuring the difference between the distance from skull to the third ventricle on both sides, using a 2 to 4 MHz probe through the temporal window. CT MLS was measured as the difference between the ideal midline and the septum pellucidum. A significant MLS was defined on head CT as > 0.5 cm.RESULTS:
A total of 52 neurosurgical ICU patients were included. The MLS (mean ± SD) was 0.32 ± 0.36 cm using TCS and 0.47 ± 0.67 cm using CT. The Pearson's correlation coefficient (r(2)) between TCS and CT scan was 0.65 (P < 0.001). The bias was 0.09 cm and the limits of agreements were 1.10 and -0.92 cm. The area under the ROC curve for detecting a significant MLS with TCS was 0.86 (95% CI = 0.74 to 0.94), and, using 0.35 cm as a cut-off, the sensitivity was 84.2%, the specificity 84.8% and the positive likelihood ratio was 5.56.CONCLUSIONS:
This study suggests that TCS could detect MLS with reasonable accuracy in neurosurgical ICU patients and that it could serve as a bedside tool to facilitate early diagnosis and treatment for patients with a significant intracranial mass effect.
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Assunto principal:
Encéfalo
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Ecoencefalografia
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Ultrassonografia Doppler Transcraniana
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Sistemas Automatizados de Assistência Junto ao Leito
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Procedimentos Neurocirúrgicos
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Unidades de Terapia Intensiva
Idioma:
En
Ano de publicação:
2014
Tipo de documento:
Article