Day-to-Day Change in Pulsatility Index Describes Anterior Cerebral Circulation Disturbance and Functional Outcomes in Pediatric Traumatic Brain Injury

BACKGROUND: Traumatic Brain Injury (TBI) is a significant source of morbidity and mortality in children. Transcranial Doppler (TCD) ultrasound measures the cerebral arterial circulation allowing for the calculation of pulsatility indices (PI) that provide an assessment of cerebral blood flow alterations. However, the use of PI in children with TBI is poorly understood and may be an important measure for the nursing care of children. OBJECTIVES: The purpose of this article is to define day-to-day PI change and to describe its relationship to injury characteristics and functional outcomes in children with TBI. METHOD: We performed a secondary analysis of a prospective observational parent study of forty children aged 2 months to 15 years of age with mild, or moderate-severe TBI who had serial TCDs. Sequential TCD PI measurements of day-to-day change revealed several consistencies among the TBI severity groups. RESULTS: Day-to-day PI change was higher in children with moderate-severe injury (40%) when compared to mild injury (21%). Greater day-to-day PI change was seen in children whose Glasgow Outcome Scale-Extended Pediatrics (GOS-E Peds) scores worsened (25%) compared to those who had an improved (19%) or unchanged GOS-E Peds scores (23%). DISCUSSION: This study is the first to report day-to-day PI change in children with TBI and provides early insights into anterior cerebral artery circulation alterations of children with TBI. Although further nursing research is needed, this study provides early evidence that TCD may be a valuable non-invasive neuromonitoring option in the management of children with TBI.