CT and Doppler devices have poor accuracy in detecting cerebral vasospasm and ischemia.

CT angiography and transcranial Doppler have limited accuracy in the detection of cerebral vasospasm and in the prediction of delayed cerebral ischemia (INN) in patients with subarachnoid hemorrhage (SAH). ) because of a broken aneurysm, reports a study in the inaugural edition of Critical Care Explorations, the official open journal of the Society of Critical Care Medicine (SCCM). The paper is published in Lippincott's portfolio by Wolters Kluwer.

"Cerebral vasospasm is frequently present on CT and transcranial Doppler, without accurate prediction of ICD or adverse outcome after six months", according to the report by J. Joep van der Harst and colleagues at the University of Groningen , in the Nederlands. The article is one of the first to be published in the new journal in open access Critical Care Explorations (CEC), which will premiere at the 48th SCCM Critical Care Conference, which opens today at the San Diego Convention Center. Designed to complement the flagship journals of the SCCM Critical Care Medicine (CCM) and Pediatric Critical Care Medicine (PCCM), CEC provides additional articles and information covering the broad area of ​​critical care.

One study compares two screening tests for cerebral vasospasm after HSA

The prospective study included 59 patients with aneurysmal HSU treated in the neurocritical care unit and the neurosurgery department of the authors between 2013 and 2016. At five and ten days, patients experienced both CT angiography and transcranial Doppler.

This study is the first to directly compare the diagnostic performance of the two tests commonly used for the early detection of cerebrovascular spasm (CVS) to detect the "feared secondary complication" of ICD. "The optimal screening modality to detect symptomatic CVS ​​is a topic of debate," the researchers write. (They also note that the causal role of CVS has not been proven.)

On both days, CT angiography showed CVS in at least one vessel in almost all patients. In contrast, transcranial Doppler showed CVS in less than half of patients. The agreement between the two tests was only 0.47.

Sixteen patients had an ICD, while 12 patients had adverse outcomes at six months. Computed tomography was very sensitive in the prediction of ICD for the prediction of ICD, but its specificity was "extremely low" compared to transcranial Doppler. At day five, the accuracy in predicting adverse outcomes was 61% with transcranial Doppler versus 27% with CT angiography.

The results suggest that CVS after aneurysmal MS is a common finding and that none of the tests is an accurate predictor of ICD or an adverse outcome. "Our study does not support a leading role in TCD or CTA screening," conclude Dr. van der Harst and his co-authors. "The detection of a CVS that does not manifest clinically probably leads to overtreatment and an extended stay in the hospital."

Critical Care Explorations debuts at the 48th Congress of Critical Care 2019

"This prospective study on an urgent clinical issue is an excellent example of the direction of our new, open-access, discovery-based journal," comments CEC Editor-in-Chief Timothy G. Buchman, PhD, MD,

MCCM, from Emory University in Atlanta, Georgia. "The open access journal offers a particularly timely review, rapid publication and global dissemination of new ideas and syntheses that practitioners can bring to the bedside."

Critical Care Explorations is designed to facilitate rapid communication of innovations and new information that may influence critical care research and practice. It has a prestigious international editorial board and follows the same rigorous peer review process. TLC and PCCM.

"As a free access newspaper, CEC the content is available at all times and is truly global, offering greater opportunities to explore international perspectives on critical care issues, "adds Dr. Buchman.An introductory editorial, describing the vision that is hiding behind CEC and providing practical information on the submission and publication process; as well as a tribute to the late Vladimir ("Vlad") Kvetan, MD, FCCM, renowned for his leadership in disaster medicine and for the innovative concept of the "USI Without Walls".