A Novel Decision Tree Approach Based on Transcranial Doppler Sonography to Screen for Blunt Cervical Vascular Injuries
Objectives Early detection and treatment of blunt cervical vascular injuries prevent adverse neurologic sequelae. Current screening criteria can miss up to 22% of these injuries. The study objective was to investigate bedside transcranial Doppler sonography for detecting blunt cervical vascular inju...
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| Veröffentlicht in: | Journal of ultrasound in medicine 2013-06, Vol.32 (6), p.1023-1031 |
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| container_title | Journal of ultrasound in medicine |
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| creator | Purvis, Dianna Aldaghlas, Tayseer Trickey, Amber W. Rizzo, Anne Sikdar, Siddhartha |
| description | Objectives
Early detection and treatment of blunt cervical vascular injuries prevent adverse neurologic sequelae. Current screening criteria can miss up to 22% of these injuries. The study objective was to investigate bedside transcranial Doppler sonography for detecting blunt cervical vascular injuries in trauma patients using a novel decision tree approach.
Methods
This prospective pilot study was conducted at a level I trauma center. Patients undergoing computed tomographic angiography for suspected blunt cervical vascular injuries were studied with transcranial Doppler sonography. Extracranial and intracranial vasculatures were examined with a portable power M‐mode transcranial Doppler unit. The middle cerebral artery mean flow velocity, pulsatility index, and their asymmetries were used to quantify flow patterns and develop an injury decision tree screening protocol. Student t tests validated associations between injuries and transcranial Doppler predictive measures.
Results
We evaluated 27 trauma patients with 13 injuries. Single vertebral artery injuries were most common (38.5%), followed by single internal carotid artery injuries (30%). Compared to patients without injuries, mean flow velocity asymmetry was higher for single internal carotid artery (P = .003) and single vertebral artery (P = .004) injuries. Similarly, pulsatility index asymmetry was higher in single internal carotid artery (P = .015) and single vertebral artery (P = .042) injuries, whereas the lowest pulsatility index was elevated for bilateral vertebral artery injuries (P = .006). The decision tree yielded 92% specificity, 93% sensitivity, and 93% correct classifications.
Conclusions
In this pilot feasibility study, transcranial Doppler measures were significantly associated with the blunt cervical vascular injury status, suggesting that transcranial Doppler sonography might be a viable bedside screening tool for trauma. Patient‐specific hemodynamic information from transcranial Doppler assessment has the potential to alter patient care pathways to improve outcomes. |
| doi_str_mv | 10.7863/ultra.32.6.1023 |
| format | Article |
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Early detection and treatment of blunt cervical vascular injuries prevent adverse neurologic sequelae. Current screening criteria can miss up to 22% of these injuries. The study objective was to investigate bedside transcranial Doppler sonography for detecting blunt cervical vascular injuries in trauma patients using a novel decision tree approach.
Methods
This prospective pilot study was conducted at a level I trauma center. Patients undergoing computed tomographic angiography for suspected blunt cervical vascular injuries were studied with transcranial Doppler sonography. Extracranial and intracranial vasculatures were examined with a portable power M‐mode transcranial Doppler unit. The middle cerebral artery mean flow velocity, pulsatility index, and their asymmetries were used to quantify flow patterns and develop an injury decision tree screening protocol. Student t tests validated associations between injuries and transcranial Doppler predictive measures.
Results
We evaluated 27 trauma patients with 13 injuries. Single vertebral artery injuries were most common (38.5%), followed by single internal carotid artery injuries (30%). Compared to patients without injuries, mean flow velocity asymmetry was higher for single internal carotid artery (P = .003) and single vertebral artery (P = .004) injuries. Similarly, pulsatility index asymmetry was higher in single internal carotid artery (P = .015) and single vertebral artery (P = .042) injuries, whereas the lowest pulsatility index was elevated for bilateral vertebral artery injuries (P = .006). The decision tree yielded 92% specificity, 93% sensitivity, and 93% correct classifications.
Conclusions
In this pilot feasibility study, transcranial Doppler measures were significantly associated with the blunt cervical vascular injury status, suggesting that transcranial Doppler sonography might be a viable bedside screening tool for trauma. Patient‐specific hemodynamic information from transcranial Doppler assessment has the potential to alter patient care pathways to improve outcomes.</description><identifier>ISSN: 0278-4297</identifier><identifier>EISSN: 1550-9613</identifier><identifier>DOI: 10.7863/ultra.32.6.1023</identifier><identifier>PMID: 23716524</identifier><language>eng</language><publisher>England: American Institute of Ultrasound in Medicine</publisher><subject>Adult ; Algorithms ; blunt cervical vascular injury ; Cerebrovascular Trauma - diagnostic imaging ; Cervical Vertebrae - blood supply ; Cervical Vertebrae - diagnostic imaging ; Cervical Vertebrae - injuries ; classification and regression tree ; Decision Support Systems, Clinical ; Female ; Humans ; Male ; Mass Screening - methods ; Pilot Projects ; Prospective Studies ; Reproducibility of Results ; Sensitivity and Specificity ; transcranial Doppler sonography ; trauma ; Ultrasonography, Doppler, Transcranial ; Wounds, Nonpenetrating - diagnostic imaging</subject><ispartof>Journal of ultrasound in medicine, 2013-06, Vol.32 (6), p.1023-1031</ispartof><rights>2016 by the American Institute of Ultrasound in Medicine</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3823-784c1e62ff8e104051e8f6ff00810cdeac1a43d09f6801cc9b758404e7fa52073</citedby><cites>FETCH-LOGICAL-c3823-784c1e62ff8e104051e8f6ff00810cdeac1a43d09f6801cc9b758404e7fa52073</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.7863%2Fultra.32.6.1023$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.7863%2Fultra.32.6.1023$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23716524$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Purvis, Dianna</creatorcontrib><creatorcontrib>Aldaghlas, Tayseer</creatorcontrib><creatorcontrib>Trickey, Amber W.</creatorcontrib><creatorcontrib>Rizzo, Anne</creatorcontrib><creatorcontrib>Sikdar, Siddhartha</creatorcontrib><title>A Novel Decision Tree Approach Based on Transcranial Doppler Sonography to Screen for Blunt Cervical Vascular Injuries</title><title>Journal of ultrasound in medicine</title><addtitle>J Ultrasound Med</addtitle><description>Objectives
Early detection and treatment of blunt cervical vascular injuries prevent adverse neurologic sequelae. Current screening criteria can miss up to 22% of these injuries. The study objective was to investigate bedside transcranial Doppler sonography for detecting blunt cervical vascular injuries in trauma patients using a novel decision tree approach.
Methods
This prospective pilot study was conducted at a level I trauma center. Patients undergoing computed tomographic angiography for suspected blunt cervical vascular injuries were studied with transcranial Doppler sonography. Extracranial and intracranial vasculatures were examined with a portable power M‐mode transcranial Doppler unit. The middle cerebral artery mean flow velocity, pulsatility index, and their asymmetries were used to quantify flow patterns and develop an injury decision tree screening protocol. Student t tests validated associations between injuries and transcranial Doppler predictive measures.
Results
We evaluated 27 trauma patients with 13 injuries. Single vertebral artery injuries were most common (38.5%), followed by single internal carotid artery injuries (30%). Compared to patients without injuries, mean flow velocity asymmetry was higher for single internal carotid artery (P = .003) and single vertebral artery (P = .004) injuries. Similarly, pulsatility index asymmetry was higher in single internal carotid artery (P = .015) and single vertebral artery (P = .042) injuries, whereas the lowest pulsatility index was elevated for bilateral vertebral artery injuries (P = .006). The decision tree yielded 92% specificity, 93% sensitivity, and 93% correct classifications.
Conclusions
In this pilot feasibility study, transcranial Doppler measures were significantly associated with the blunt cervical vascular injury status, suggesting that transcranial Doppler sonography might be a viable bedside screening tool for trauma. Patient‐specific hemodynamic information from transcranial Doppler assessment has the potential to alter patient care pathways to improve outcomes.</description><subject>Adult</subject><subject>Algorithms</subject><subject>blunt cervical vascular injury</subject><subject>Cerebrovascular Trauma - diagnostic imaging</subject><subject>Cervical Vertebrae - blood supply</subject><subject>Cervical Vertebrae - diagnostic imaging</subject><subject>Cervical Vertebrae - injuries</subject><subject>classification and regression tree</subject><subject>Decision Support Systems, Clinical</subject><subject>Female</subject><subject>Humans</subject><subject>Male</subject><subject>Mass Screening - methods</subject><subject>Pilot Projects</subject><subject>Prospective Studies</subject><subject>Reproducibility of Results</subject><subject>Sensitivity and Specificity</subject><subject>transcranial Doppler sonography</subject><subject>trauma</subject><subject>Ultrasonography, Doppler, Transcranial</subject><subject>Wounds, Nonpenetrating - diagnostic imaging</subject><issn>0278-4297</issn><issn>1550-9613</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkU1PGzEQhq2KqgTac2_IRy4b_G2vOIW0fFS0PQC9WsYZl0XOerGzQfn3mIT2ymVGGj3zSjMPQl8pmWqj-MkYV9lNOZuqKSWMf0ATKiVpWkX5HpoQpk0jWKv30UEpj4QwQrX4hPYZ11RJJiZoPcO_0hoi_ga-K13q8W0GwLNhyMn5B3zmCizwduz64mvpXIXTMETI-Cb16W92w8MGrxK-8XW1xyFlfBbHfoXnkNedr_wfV_wYXcZX_eOYOyif0cfgYoEvb_0Q3Z1_v51fNte_L67ms-vGc8N4o43wFBQLwQAlgkgKJqgQCDGU-AU4T53gC9IGZQj1vr3X0ggiQAcnGdH8EB3vcus5TyOUlV12xUOMroc0Flu_RRVXupXvo1yqViojaEVPdqjPqZQMwQ65W7q8sZTYVy9268VyZpV99VI3jt7Cx_slLP7z_0RU4HQHPHcRNu_l2R93P6tLzpnaxr8AHvGb2A</recordid><startdate>201306</startdate><enddate>201306</enddate><creator>Purvis, Dianna</creator><creator>Aldaghlas, Tayseer</creator><creator>Trickey, Amber W.</creator><creator>Rizzo, Anne</creator><creator>Sikdar, Siddhartha</creator><general>American Institute of Ultrasound in Medicine</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>7QO</scope><scope>8FD</scope><scope>FR3</scope><scope>P64</scope></search><sort><creationdate>201306</creationdate><title>A Novel Decision Tree Approach Based on Transcranial Doppler Sonography to Screen for Blunt Cervical Vascular Injuries</title><author>Purvis, Dianna ; Aldaghlas, Tayseer ; Trickey, Amber W. ; Rizzo, Anne ; Sikdar, Siddhartha</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3823-784c1e62ff8e104051e8f6ff00810cdeac1a43d09f6801cc9b758404e7fa52073</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Adult</topic><topic>Algorithms</topic><topic>blunt cervical vascular injury</topic><topic>Cerebrovascular Trauma - diagnostic imaging</topic><topic>Cervical Vertebrae - blood supply</topic><topic>Cervical Vertebrae - diagnostic imaging</topic><topic>Cervical Vertebrae - injuries</topic><topic>classification and regression tree</topic><topic>Decision Support Systems, Clinical</topic><topic>Female</topic><topic>Humans</topic><topic>Male</topic><topic>Mass Screening - methods</topic><topic>Pilot Projects</topic><topic>Prospective Studies</topic><topic>Reproducibility of Results</topic><topic>Sensitivity and Specificity</topic><topic>transcranial Doppler sonography</topic><topic>trauma</topic><topic>Ultrasonography, Doppler, Transcranial</topic><topic>Wounds, Nonpenetrating - diagnostic imaging</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Purvis, Dianna</creatorcontrib><creatorcontrib>Aldaghlas, Tayseer</creatorcontrib><creatorcontrib>Trickey, Amber W.</creatorcontrib><creatorcontrib>Rizzo, Anne</creatorcontrib><creatorcontrib>Sikdar, Siddhartha</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>Biotechnology Research Abstracts</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>Biotechnology and BioEngineering Abstracts</collection><jtitle>Journal of ultrasound in medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Purvis, Dianna</au><au>Aldaghlas, Tayseer</au><au>Trickey, Amber W.</au><au>Rizzo, Anne</au><au>Sikdar, Siddhartha</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A Novel Decision Tree Approach Based on Transcranial Doppler Sonography to Screen for Blunt Cervical Vascular Injuries</atitle><jtitle>Journal of ultrasound in medicine</jtitle><addtitle>J Ultrasound Med</addtitle><date>2013-06</date><risdate>2013</risdate><volume>32</volume><issue>6</issue><spage>1023</spage><epage>1031</epage><pages>1023-1031</pages><issn>0278-4297</issn><eissn>1550-9613</eissn><abstract>Objectives
Early detection and treatment of blunt cervical vascular injuries prevent adverse neurologic sequelae. Current screening criteria can miss up to 22% of these injuries. The study objective was to investigate bedside transcranial Doppler sonography for detecting blunt cervical vascular injuries in trauma patients using a novel decision tree approach.
Methods
This prospective pilot study was conducted at a level I trauma center. Patients undergoing computed tomographic angiography for suspected blunt cervical vascular injuries were studied with transcranial Doppler sonography. Extracranial and intracranial vasculatures were examined with a portable power M‐mode transcranial Doppler unit. The middle cerebral artery mean flow velocity, pulsatility index, and their asymmetries were used to quantify flow patterns and develop an injury decision tree screening protocol. Student t tests validated associations between injuries and transcranial Doppler predictive measures.
Results
We evaluated 27 trauma patients with 13 injuries. Single vertebral artery injuries were most common (38.5%), followed by single internal carotid artery injuries (30%). Compared to patients without injuries, mean flow velocity asymmetry was higher for single internal carotid artery (P = .003) and single vertebral artery (P = .004) injuries. Similarly, pulsatility index asymmetry was higher in single internal carotid artery (P = .015) and single vertebral artery (P = .042) injuries, whereas the lowest pulsatility index was elevated for bilateral vertebral artery injuries (P = .006). The decision tree yielded 92% specificity, 93% sensitivity, and 93% correct classifications.
Conclusions
In this pilot feasibility study, transcranial Doppler measures were significantly associated with the blunt cervical vascular injury status, suggesting that transcranial Doppler sonography might be a viable bedside screening tool for trauma. Patient‐specific hemodynamic information from transcranial Doppler assessment has the potential to alter patient care pathways to improve outcomes.</abstract><cop>England</cop><pub>American Institute of Ultrasound in Medicine</pub><pmid>23716524</pmid><doi>10.7863/ultra.32.6.1023</doi><tpages>9</tpages></addata></record> |
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| ispartof | Journal of ultrasound in medicine, 2013-06, Vol.32 (6), p.1023-1031 |
| issn | 0278-4297 1550-9613 |
| language | eng |
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| source | MEDLINE; Wiley Online Library Journals Frontfile Complete |
| subjects | Adult Algorithms blunt cervical vascular injury Cerebrovascular Trauma - diagnostic imaging Cervical Vertebrae - blood supply Cervical Vertebrae - diagnostic imaging Cervical Vertebrae - injuries classification and regression tree Decision Support Systems, Clinical Female Humans Male Mass Screening - methods Pilot Projects Prospective Studies Reproducibility of Results Sensitivity and Specificity transcranial Doppler sonography trauma Ultrasonography, Doppler, Transcranial Wounds, Nonpenetrating - diagnostic imaging |
| title | A Novel Decision Tree Approach Based on Transcranial Doppler Sonography to Screen for Blunt Cervical Vascular Injuries |
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