الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Traumatic brain injury (TBI) is a critical public health problem throughout the world.. Neurological outcome after traumatic brain injury (TBI) depends on the severity of initial injuries and the extent of secondary cerebral damage. Prevention and treatment of such secondary injuries are the focus of modern TBI management. The (GCS) and pupil reactivity are used as initial triage tools in trauma, but they are far from perfect. While intended to be reproducible and a ‘common language’ between providers, inter-rater reliability has been shown to be poor. Transcranial Doppler is well established and currently clinically available. Similar to (FAST), application of this non-invasive technology can allow early assessment of disease and is especially desirable in the far forward arena or when conventional imaging is not available. Transcranial Doppler ultrasound (TCD) can measure cerebral blood flow velocity in the main intracranial vessels non-invasively and with high accuracy. Combined with the availability of non-invasive devices for continuous measurement of arterial blood pressure, the relatively low cost, ease-of-use, and excellent temporal resolution of TCD have stimulated the development of new techniques to assess cerebral autoregulation in the laboratory or bedside using a dynamic approach, instead of the more classical ’static’ method. Clinical applications have shown consistent results in certain conditions such as head injury and carotid artery disease. 117 This study aimed to evaluate the role of transcranial US in assessment, prediction of the outcome and follow up of patients of moderate to severe traumatic brain injury. This was prospective study was conducted on 60 patients aged 18 to 66 years old with traumatic brain injury, GCS equal or less than 12 and recent trauma (less than 6 hours after trauma). All patients underwent resuscitation, full history taking, clinical examination, transcranial doppler ultrasound on both sides on admission and over a period of one month and brain CT scan. Summary of our results: Fifty-one patient were injured as a result of road traffic accidents, while7 injuries resulted from falling from height and the other two cases resulted from local head trauma. Regarding CT brain findings for our patients, Multiple hemorrhagic contusions were found in 25 (41.67%) patients, Brain edema was found in 11 (18.33%) patients, 20 (33.33%)cases had subarachnoid hemorrhage, 8 (13.33%) cases had Thin Rim subdural or Thin Rim extradural hemorrhage, 3 (5%) cases showed intraventricular, Skull fractures were present in 11 (18.33%) and 3 cases showed unremarkable findings in CT. Regarding trauma survey of studied patients in addition to traumatic brain injury 21 (35%) patients had chest trauma, 10 (16.67%) patients had intra-abdominal injury, Long bone fractures were found in 5 (8.33%) patients and 21 patients had isolated traumatic brain injury. Regarding GOS, patients who had favorable outcome are patients with GOS score 2 and 1 (patients with moderate disability or good recovery) represented about 33 (55%). Meanwhile, patients who had unfavorable 118 outcome are patients with GOS score 3,4 and 5(patients with severe disability, vegetative, death) represented about 27 (45%). Regarding to occurrence of secondary insults, 10 patients (16.67%) had seizures, while 26 (43.33%) patients had sepsis,16 (26.67%) patients had hypoxia, only 16 (26.67%) patients had no secondary insult 7 days after admission. Regarding mortality 11 (18.33%) patients died within 28 days after admission the other survived. About 33 (55%) had favorable outcome. Regarding relationship between TCD and GOS after 28 days, TCD parameters were normal in 47(78,3%) while abnormal findings were recorded in 13(21.7%) patients. Hypo perfusion was detected in 9(15%) and 4(6.6%) patients showed vasospasm. Regarding relationship between TCD and patient’s outcomes, PSV, EDV, MFV, and only PI on admission, was significantly higher in patients with favorable outcome and showed good correlation with outcome. AU-ROC assessing for GOS prediction using TCD measurements recorded, PSV showed sensitivity of 66.67%, specificity of 78.79%, PPV of 72% and NPV of 74.3% with best cut off value of ≤80 in predicting patients with unfavorable outcome at day 28 after trauma. EDV showed sensitivity of 74.07%, specificity of 90.91%, PPV of 87% and NPV of 81.1% with best cut off value of ≤35in predicting patients with unfavorable outcome at day 28 after trauma. MFV showed sensitivity of 70.37specificity of 87.88, PPV of 82.6% and NPV of 78.4% with best cut off value of ≤50 in predicting patients with unfavorable outcome at day 28 after trauma. 119 PI showed sensitivity of 66.67%, specificity of 100.00%, PPV of 100% and NPV of 78.6% with best cut off value of >1 in predicting patients with unfavorable outcome at day 28 after trauma. Regarding relationship between TCD and mortality of the studied patients, PSV, EDV, and MFV was significantly higher in survived patients and showed good correlation with outcome Only PI on admission, on day 21 and on day 28 was correlated with outcome, while PI on day 7 and 14showed no correlation with outcome with p value 0.110 and 0.080. AU-ROC assessing for mortality prediction using TCD measurements recorded, PSV showed sensitivity of 72.73%, specificity of 65.31%, PPV of 29.6% and NPV of 90.9% with best cut off value of ≤80 in predicting mortality. EDV showed sensitivity of 90.91%, specificity of 77.55%, PPV of 47.6% and NPV of 97.4% with best cut off value of ≤30 in predicting mortality. MFV showed sensitivity of 100. % Specificity of 65.3%, PPV of 39.3% and NPV of 100.0% with best cut off value of ≤56.7 in predicting mortality. PI showed sensitivity of 81.82%, specificity of 81.63%, PPV of 50.0% and NPV of 95.2% with best cut off value of >1 in predicting mortality.