{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T12:28:17Z","timestamp":1787228897895,"version":"build-2736575974"},"reference-count":30,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","license":[{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Traumatic brain injury (TBI) is a leading cause of death and long-term disability worldwide, particularly among young adults in low- and middle-income countries. Even patients presenting with mild-to-moderate TBI may experience secondary neurological deterioration due to evolving intracranial pathology. Early identification of patients at risk remains challenging. Transcranial Doppler (TCD) ultrasonography provides a noninvasive bedside assessment of cerebral hemodynamics, and the pulsatility index (PI) reflects downstream cerebrovascular resistance and intracranial compliance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>This prospective observational study included 100 adult patients with mild-to-moderate TBI admitted to a tertiary care intensive care unit (ICU). Demographic data, mechanism of injury, clinical status, and computed tomography (CT) findings were recorded. TCD examination was performed at admission to measure middle cerebral artery velocities and calculate PI. Patients were followed for seven days. Neurological deterioration was defined as a decrease in Glasgow Coma Scale score by \u22652 points, requirement of mechanical ventilation, or need for neurosurgical intervention. Receiver operating characteristic (ROC) curve analysis and multivariate logistic regression were used to assess the predictive value of PI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Neurological deterioration occurred in 22% of patients. Admission PI was significantly higher in patients who deteriorated compared with those who remained stable (1.35 \u00b1 0.18 vs. 1.14 \u00b1 0.17;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001). ROC analysis demonstrated that PI predicted neurological deterioration with an area under the curve of 0.82 (95% confidence interval (CI): 0.73\u20130.91). A PI cutoff value of \u22651.25 yielded a sensitivity of 77% and a specificity of 80%. On multivariate analysis, admission PI \u22651.25 independently predicted neurological deterioration (adjusted OR 4.3; 95% CI 1.7\u201310.8).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Admission PI measured by TCD is a reliable, noninvasive predictor of early neurological deterioration in patients with mild-to-moderate TBI and may aid early risk stratification in the ICU.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/sja.sja_824_25","type":"journal-article","created":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T05:00:47Z","timestamp":1782968447000},"page":"525-532","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Role of transcranial Doppler pulsatility index for predicting neurological deterioration in mild-to-moderate traumatic brain injury patients in intensive care unit"],"prefix":"10.4103","volume":"20","author":[{"given":"Sachreet","family":"Kaur","sequence":"first","affiliation":[{"name":"Department of Anaesthesia and Critical Care, SGRD University, Amritsar, Punjab, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nisha","family":"Rani","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia and Critical Care, SGRD University, Amritsar, Punjab, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,7,2]]},"reference":[{"key":"R1-20260820","doi-asserted-by":"crossref","first-page":"987","DOI":"10.1016\/S1474-4422(17)30371-X","article-title":"Traumatic brain injury: Integrated approaches to improve prevention, clinical care, and research","volume":"16","author":"Maas","year":"2017","journal-title":"Lancet Neurol"},{"key":"R2-20260820","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1038\/nrneurol.2013.22","article-title":"Changing patterns in the epidemiology of traumatic brain injury","volume":"9","author":"Roozenbeek","year":"2013","journal-title":"Nat Rev Neurol"},{"key":"R3-20260820","doi-asserted-by":"crossref","first-page":"341","DOI":"10.3233\/NRE-2007-22502","article-title":"The impact of traumatic brain injuries: A global perspective","volume":"22","author":"Hyder","year":"2007","journal-title":"NeuroRehabilitation"},{"key":"R4-20260820","doi-asserted-by":"crossref","first-page":"1683","DOI":"10.1007\/s00701-015-2512-7","article-title":"Epidemiology of traumatic brain injury in Europe","volume":"157","author":"Peeters","year":"2015","journal-title":"Acta Neurochir (Wien)"},{"key":"R5-20260820","doi-asserted-by":"crossref","first-page":"1","DOI":"10.15585\/mmwr.ss6609a1","article-title":"Traumatic brain injury\u2013related emergency department visits, hospitalizations, and deaths \u2014 United States, 2007 and 2013","volume":"66","author":"Taylor","year":"2017","journal-title":"MMWR Surveill Summ"},{"key":"R6-20260820","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1186\/s13054-016-1318-1","article-title":"Chronic impact of traumatic brain injury on outcome and quality of life: A narrative review","volume":"20","author":"Stocchetti","year":"2016","journal-title":"Crit Care"},{"key":"R7-20260820","first-page":"153","article-title":"Transcranial Doppler after traumatic brain injury: Is there a role?","volume":"20","author":"Bouzat","year":"2014","journal-title":"Curr Opin Crit Care"},{"key":"R8-20260820","first-page":"245","article-title":"Transcranial Doppler to predict neurological worsening after mild to moderate traumatic brain injury","volume":"24","author":"Bouzat","year":"2016","journal-title":"Neurocrit Care"},{"key":"R9-20260820","first-page":"36","article-title":"Prognostic role of transcranial Doppler ultrasonography in severe traumatic brain injury","volume":"54","author":"Zaytoun","year":"2017","journal-title":"Egypt J Neurol Psychiatr Neurosurg"},{"key":"R10-20260820","first-page":"190","article-title":"Role of transcranial Doppler in the management of traumatic brain injury: An observational study","volume":"4","author":"Prasad","year":"2017","journal-title":"J Neuroanaesth Crit Care"},{"key":"R11-20260820","first-page":"671","article-title":"Prognostic significance of transcranial Doppler monitoring in traumatic brain injury: A systematic review and meta analysis","volume":"33","author":"Fatima","year":"2019","journal-title":"Brain Inj"},{"key":"R12-20260820","first-page":"89","article-title":"Combined value of Glasgow Coma Scale and transcranial Doppler pulsatility index for prediction of neurological deterioration in traumatic brain injury","volume":"7","author":"Abdelhaleem","year":"2019","journal-title":"Egypt J Crit Care Med"},{"key":"R13-20260820","first-page":"1165372","article-title":"Clinical utility of transcranial Doppler ultrasonography in traumatic brain injury: Current perspectives","volume":"14","author":"Razumovsky","year":"2023","journal-title":"Front Neurol"},{"key":"R14-20260820","doi-asserted-by":"crossref","first-page":"769","DOI":"10.3171\/jns.1982.57.6.0769","article-title":"Noninvasive transcranial Doppler ultrasound recording of flow velocity in basal cerebral arteries","volume":"57","author":"Aaslid","year":"1982","journal-title":"J Neurosurg"},{"key":"R15-20260820","first-page":"R159","article-title":"Reliability of the pulsatility index to reflect intracranial pressure in head injured patients: An observational study","volume":"16","author":"Zweifel","year":"2012","journal-title":"Crit Care"},{"key":"R16-20260820","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1016\/j.surneu.2003.12.007","article-title":"Transcranial Doppler sonography pulsatility index (PI) reflects intracranial pressure (ICP)","volume":"62","author":"Bellner","year":"2004","journal-title":"Surg Neurol"},{"key":"R17-20260820","doi-asserted-by":"crossref","first-page":"258","DOI":"10.1007\/s12028-011-9630-8","article-title":"Critical thresholds for cerebrovascular reactivity after traumatic brain injury","volume":"16","author":"Sorrentino","year":"2012","journal-title":"Neurocrit Care"},{"key":"R18-20260820","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1097\/00006123-199707000-00005","article-title":"Continuous assessment of the cerebral vasomotor reactivity in head injury","volume":"41","author":"Czosnyka","year":"1997","journal-title":"Neurosurgery"},{"key":"R19-20260820","doi-asserted-by":"crossref","first-page":"1050","DOI":"10.1227\/01.NEU.0000369519.35932.F2","article-title":"Transcranial Doppler pulsatility index: Not an accurate method to assess intracranial pressure","volume":"66","author":"Behrens","year":"2010","journal-title":"Neurosurgery"},{"key":"R20-20260820","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1007\/BF00314307","article-title":"Evaluation of intracranial pressure from transcranial Doppler studies in cerebral disease","volume":"235","author":"Klingelh\u00f6fer","year":"1988","journal-title":"J Neurol"},{"key":"R21-20260820","doi-asserted-by":"crossref","first-page":"813","DOI":"10.1136\/jnnp.2003.033126","article-title":"Monitoring and interpretation of intracranial pressure","volume":"75","author":"Czosnyka","year":"2004","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"R22-20260820","first-page":"279","article-title":"Ultrasound non invasive intracranial pressure assessment in neurointensive care: Aprospective observational study","volume":"21","author":"Robba","year":"2017","journal-title":"Crit Care"},{"key":"R23-20260820","doi-asserted-by":"crossref","first-page":"E2","DOI":"10.3171\/FOC.2008.25.10.E2","article-title":"Continuous monitoring of cerebrovascular pressure reactivity in patients with head injury","volume":"25","author":"Zweifel","year":"2008","journal-title":"Neurosurg Focus"},{"key":"R24-20260820","first-page":"706","article-title":"Value of transcranial Doppler indices in predicting raised intracranial pressure in hydrocephalus","volume":"83","author":"Hanlo","year":"1995","journal-title":"J Neurosurg"},{"key":"R25-20260820","first-page":"820","article-title":"Continuous monitoring of cerebrovascular reactivity: A validation study","volume":"74","author":"Lang","year":"2003","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"R26-20260820","first-page":"675","article-title":"Clinical evaluation of a noninvasive ultrasonic device for detecting increased intracranial pressure","volume":"69","author":"Robertson","year":"1988","journal-title":"J Neurosurg"},{"key":"R27-20260820","first-page":"593","article-title":"Transcranial Doppler in traumatic brain injury patients: A critical review","volume":"32","author":"Tazarourte","year":"2019","journal-title":"Curr Opin Anaesthesiol"},{"key":"R28-20260820","first-page":"761","article-title":"Evaluation of cerebral autoregulation in head-injured patients: A noninvasive method using transcranial Doppler","volume":"85","author":"Smielewski","year":"1996","journal-title":"J Neurosurg"},{"key":"R29-20260820","doi-asserted-by":"crossref","first-page":"981","DOI":"10.1007\/s00134-006-0173-y","article-title":"Applications of transcranial Doppler in the ICU: A review","volume":"32","author":"White","year":"2006","journal-title":"Intensive Care Med"},{"key":"R30-20260820","first-page":"28","article-title":"Non-invasive assessment of intracranial pressure using transcranial Doppler: Is it clinically useful?","volume":"32","author":"Robba","year":"2020","journal-title":"J Neurosurg Anesthesiol"}],"container-title":["Saudi Journal of Anaesthesia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/sja.sja_824_25","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T12:01:24Z","timestamp":1787227284000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/sja.sja_824_25"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7]]},"references-count":30,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.4103\/sja.sja_824_25","relation":{},"ISSN":["1658-354X","0975-3125"],"issn-type":[{"value":"1658-354X","type":"print"},{"value":"0975-3125","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7]]},"assertion":[{"value":"2025-10-13","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-01-22","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}