Prediction of early treatment outcomes in patients with traumatic brain injury using transcranial Doppler ultrasound combined with invasive intracranial pressure

To investigate the predictive role of transcranial Doppler (TCD) ultrasound combined with invasive intracranial pressure (ICP) monitoring in the early outcomes for patients with moderate-to-severe traumatic brain injury (msTBI) after ICP probe insertion surgery.

A retrospective case-control analysis was conducted on the clinical data of 65 msTBI patients who underwent invasive ICP probe insertion surgery within 24 h after injury and routine TCD examination postoperatively in No. 904 Hospital of Joint Logistic Support Force of Chinese PLA between January 2021 and March 2025. Based on whether disease progression met the indications for craniotomy, they were divided into a failed conservative treatm ent group (n=28) and a successful conservative treatment group (n=37). Baseline clinical data, and parameters of TCD and ICP monitoring were collected in both groups. Univariate analysis was used for comparing differences in various parameters between the groups. The variables related to ICP and TCD were denoted as Model 1, and variables that significantly affected the outcome were incorporated as potential confounding factors into Model 2 based on clinical experience. Multivariate logistic regression analysis was performed to screen for independent predictors of conservative treatment failure. Receiver operating characteristic (ROC) curves were plotted to evaluate the diagnostic efficacy of each predictive factor.

Statistical differences were observed between the 2 groups in terms of Glasgow Coma Scale (GCS) score at admission, postoperative mean intracranial pressure (ICPm), postoperative mean cerebral perfusion pressure (CPPm), and pulsatility index (PI) of the ipsilateral internal carotid artery extracranial segment (ICAt), and mean flow velocity (Vm) and pulsatility index (PI) of the ipsilateral middle cerebral artery (MCA) (all P<0.01). After adjusting for age, GCS score at admission, hematoma volum, and mean postoperative brain temperature, multivariate logistic regression analysis revealed that ICPm (OR=1.248, 95%CI: 1.044~1.491, P=0.015), ipsilateral MCA. Vm (OR=0.964, 95%CI: 0.933~0.997, P=0.034), and ipsilateral MCA. PI (OR=1.612, 95%CI: 1.026~2.533, P=0.038) were independent predictors of failure in conservative treatment in msTBI patients. After adjustment, ROC curve analysis demonstrated that the combined model of ipsilateral MCA. PI, ipsilateral MCA. Vm, and ICPm achieved a predictive efficacy of 0.931 (95%CI: 0.873~0.988), which was obviously higher than that of the single model of ICPm (0.875, 95%CI: 0.791~0.959).

Combined monitoring of TCD and ICP can provide a more accurate prediction of the early outcomes for msTBI patients after ICP probe insertion, providing a more effective assessment for clinical diagnosis and treatment.