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Abstract：
BACKGROUND: Transcranial Doppler (TCD) is a technique to assess blood flow velocity in the cerebral arteries. TCD is frequently used to monitor aneurysmal subarachnoid hemorrhage (aSAH) patients. This study compares TCD-criteria for vasospasm and its association with Delayed Cerebral Ischemia (DCI). An overall score based on flow velocities of various intracranial arteries was developed and evaluated.
METHODS: A retrospective diagnostic accuracy study was conducted between 1998 and 2017 with 621 patients included. Mean flow velocity (MFV) of the cerebral artery was measured between 2-5 days and between 6-9 days after ictus. Cutoff values from the literature, new cutoff values, and a new composite score (Combined Severity Score) were used to predict DCI. Sensitivity, specificity, and area under the curve (AUC) were determined, and logistic regression analysis was performed.
RESULTS: The Combined Severity Score showed an AUC 0.64 (95%CI 0.56-.71) at days 2-5, with sensitivity 0.53 and specificity 0.74. The Combined Severity Score had an adjusted Odds Ratio of 3.41 (95CI 1.86-6.32) for DCI. MCA-measurements yielded the highest AUC to detect DCI at day 2-5: AUC 0.65 (95%CI 0.58-0.73). Optimal cutoff MFV of 83 cm/s for MCA resulted in sensitivity 0.73 and specificity 0.50 at days 2-5.
CONCLUSIONS: TCD-monitoring of aSAH patients may be a valuable strategy for DCI risk stratification. Lower cutoff values can be used in the early phase after the ictus (day 2-5) than are commonly used now. The Combined Severity Score incorporating all major cerebral arteries may provide a meaningful contribution to interpreting TCD measurements.
METHODS: A retrospective diagnostic accuracy study was conducted between 1998 and 2017 with 621 patients included. Mean flow velocity (MFV) of the cerebral artery was measured between 2-5 days and between 6-9 days after ictus. Cutoff values from the literature, new cutoff values, and a new composite score (Combined Severity Score) were used to predict DCI. Sensitivity, specificity, and area under the curve (AUC) were determined, and logistic regression analysis was performed.
RESULTS: The Combined Severity Score showed an AUC 0.64 (95%CI 0.56-.71) at days 2-5, with sensitivity 0.53 and specificity 0.74. The Combined Severity Score had an adjusted Odds Ratio of 3.41 (95CI 1.86-6.32) for DCI. MCA-measurements yielded the highest AUC to detect DCI at day 2-5: AUC 0.65 (95%CI 0.58-0.73). Optimal cutoff MFV of 83 cm/s for MCA resulted in sensitivity 0.73 and specificity 0.50 at days 2-5.
CONCLUSIONS: TCD-monitoring of aSAH patients may be a valuable strategy for DCI risk stratification. Lower cutoff values can be used in the early phase after the ictus (day 2-5) than are commonly used now. The Combined Severity Score incorporating all major cerebral arteries may provide a meaningful contribution to interpreting TCD measurements.
摘要：
背景：经颅多普勒（TCD）是一种评估脑动脉血流速度的技术。TCD经常用于监测动脉瘤性蛛网膜下腔出血（aSAH）患者。这项研究比较了TCD标准的血管痉挛及其与延迟性脑缺血（DCI）的关系。制定并评估了基于各种颅内动脉流速的总体评分。
方法：在1998年至2017年之间进行了一项回顾性诊断准确性研究，包括621例患者。在发作后2-5天和6-9天之间测量脑动脉的平均流速（MFV）。来自文献的截止值，新的截止值，新的综合评分（综合严重程度评分）用于预测DCI。灵敏度,特异性，并测定曲线下面积(AUC),并进行logistic回归分析。
结果：在第2-5天，综合严重程度评分显示AUC为0.64（95CI0.56-.71），敏感性为0.53，特异性为0.74。对于DCI，综合严重度评分的调整赔率比为3.41(95CI1.86-6.32)。MCA测量在第2-5天产生检测DCI的最高AUC:AUC0.65(95CI0.58-0.73)。MCA的83cm/s的最佳截止MFV在第2-5天导致灵敏度0.73和特异性0.50。
结论：对aSAH患者进行TCD监测可能是DCI风险分层的一种有价值的策略。在发病后的早期阶段（第2-5天）可以使用比现在通常使用的更低的临界值。合并所有主要脑动脉的综合严重程度评分可能为解释TCD测量值提供有意义的贡献。
方法：在1998年至2017年之间进行了一项回顾性诊断准确性研究，包括621例患者。在发作后2-5天和6-9天之间测量脑动脉的平均流速（MFV）。来自文献的截止值，新的截止值，新的综合评分（综合严重程度评分）用于预测DCI。灵敏度,特异性，并测定曲线下面积(AUC),并进行logistic回归分析。
结果：在第2-5天，综合严重程度评分显示AUC为0.64（95CI0.56-.71），敏感性为0.53，特异性为0.74。对于DCI，综合严重度评分的调整赔率比为3.41(95CI1.86-6.32)。MCA测量在第2-5天产生检测DCI的最高AUC:AUC0.65(95CI0.58-0.73)。MCA的83cm/s的最佳截止MFV在第2-5天导致灵敏度0.73和特异性0.50。
结论：对aSAH患者进行TCD监测可能是DCI风险分层的一种有价值的策略。在发病后的早期阶段（第2-5天）可以使用比现在通常使用的更低的临界值。合并所有主要脑动脉的综合严重程度评分可能为解释TCD测量值提供有意义的贡献。
