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01.12.2014 | Research | Ausgabe 6/2014 Open Access

Critical Care 6/2014

Assessment of brain midline shift using sonography in neurosurgical ICU patients

Zeitschrift:
Critical Care > Ausgabe 6/2014
Autoren:
Julie Motuel, Isaure Biette, Mohamed Srairi, Ségolène Mrozek, Matt M Kurrek, Patrick Chaynes, Christophe Cognard, Olivier Fourcade, Thomas Geeraerts
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​s13054-014-0676-9) contains supplementary material, which is available to authorized users.

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

JM conceived the study, participated in its design, carried out the data acquisition and drafted the manuscript. IB participated in the design of the study, carried out the data acquisition and helped to draft the manuscript. MS performed the statistical analysis, provided critical revision and substantial contributions to the manuscript. SM provided critical revision and substantial contributions to the manuscript. MK provided critical revision, English editing and substantial contributions to the manuscript. PC provided critical revision, and substantial contributions to the manuscript. CC participated in the study design and coordination and helped to draft and critically revise the manuscript. OF participated in the study design and coordination and helped to draft and critically revise the manuscript. TG planned, designed and coordinated the study, performed the statistical analysis, interpreted the results and drafted and revised the manuscript. All authors read and approved the final manuscript.

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 (r2) 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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