Jason J Chang1, Matthew Triano2, Maite J Corbin2, Sameer Desale3, Ai-Hsi Liu4, Daniel R Felbaum5, Jeffrey C Mai5, Rocco A Armonda5, Edward F Aulisi5. 1. Department of Critical Care Medicine. MedStar Washington Hospital Center. Washington, DC, USA.; Department of Neurology. Georgetown University Medical Center. Washington, DC, USA.. Electronic address: jjwchang@hotmail.com. 2. Department of Critical Care Medicine. MedStar Washington Hospital Center. Washington, DC, USA. 3. Department of Biostatistics and Biomedical Informatics, MedStar Health Research Institute. Washington, DC, USA. 4. Department of Radiology. MedStar Washington Hospital Center. Washington, DC, USA. 5. Department of Neurosurgery. Georgetown University and MedStar Washington Hospital Center. Washington, DC, USA.
Abstract
BACKGROUND AND PURPOSE: We evaluated optimal transcranial Doppler (TCD) measures for predicting delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage (aSAH). MATERIAL AND METHODS: Consecutive patients with aSAH and daily middle cerebral artery (MCA) TCD recordings were retrospectively analyzed. Change in TCD velocity was obtained by creating a smoothing curve. Change in TCD velocity was determined with a linear regression model that confirmed greatest change in velocity associated with DCI occurred at days 2-7. Multivariate logistic regression analysis was then completed. RESULTS: 95 patients were evaluated. Increase in TCD velocity at days 2-7 proved to be the best predictor for DCI with an optimal cutoff of 8.9 cm/s/day (p = .019) and AUC 0.651. Multivariate logistic regression analysis using DCI as outcome showed that poor admission Hunt-Hess scores (OR 5.02, 95%CI 1.22-22.67, p = .028) and increases in TCD velocity (OR 5.32, 95%CI 1.41-23.33, p = .018) were independently associated with DCI. CONCLUSIONS: We found that relative increases in TCD velocities in the MCAs during the first 7 days (with a threshold increase of 53.4 cm/s from days 2 to 7) after aSAH admission were independently associated with DCI. This association requires independent confirmation.
BACKGROUND AND PURPOSE: We evaluated optimal transcranial Doppler (TCD) measures for predicting delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage (aSAH). MATERIAL AND METHODS: Consecutive patients with aSAH and daily middle cerebral artery (MCA) TCD recordings were retrospectively analyzed. Change in TCD velocity was obtained by creating a smoothing curve. Change in TCD velocity was determined with a linear regression model that confirmed greatest change in velocity associated with DCI occurred at days 2-7. Multivariate logistic regression analysis was then completed. RESULTS: 95 patients were evaluated. Increase in TCD velocity at days 2-7 proved to be the best predictor for DCI with an optimal cutoff of 8.9 cm/s/day (p = .019) and AUC 0.651. Multivariate logistic regression analysis using DCI as outcome showed that poor admission Hunt-Hess scores (OR 5.02, 95%CI 1.22-22.67, p = .028) and increases in TCD velocity (OR 5.32, 95%CI 1.41-23.33, p = .018) were independently associated with DCI. CONCLUSIONS: We found that relative increases in TCD velocities in the MCAs during the first 7 days (with a threshold increase of 53.4 cm/s from days 2 to 7) after aSAH admission were independently associated with DCI. This association requires independent confirmation.
Authors: Kevin Clare; Alan Stein; Nitesh Damodara; Eric Feldstein; Hussein Alshammari; Syed Ali; Christeena Kurian; Jon Rosenberg; Andrew Bauerschmidt; Gurmeen Kaur; Justin Santarelli; Robert Hamilton; Stephan Mayer; Chirag D Gandhi; Fawaz Al-Mufti Journal: Sci Rep Date: 2022-02-10 Impact factor: 4.379