AIM- 

To determine  diagnostic performance of  Point of care transcranial colour doppler sonography   for ruling -in intracranial hypertension and correlating with CT imaging  in early phase of critical head injuries during primary survey 

METHODS 

Consent for participation in the observational trial will be taken from the blood relatives of the patient. Screening for possible enrolment will begin on arrival to triage. Details of the referral and treatment given before arrival to the hospital will be recorded and entered into a performa. The primary and secondary survey will be conducted by the on-duty doctor based on Advanced Trauma Life Support (ATLS) protocol. Those patients who show a lower GCS<12 post resuscitation will be subsequently enrolled. Recording of baseline vitals (heart rate, saturation, Blood pressure) will be done utilizing vital sign bedside monitor. A Baseline arterial blood gas sample will be withdrawn from radial artery and sent for analysis.

Transcranial Colour Doppler (TCCD) will be performed on both sides in trans temporal window by using 1-5Mhz phased array ultrasound transducer Transducer will be positioned over the trans temporal window with pointer towards the patient’s front immediately in front of tragus and above the zygomatic arch over the temporal area orienting upwards anteriorly Once the contralateral and ipsilateral temporal bones are identified, cerebral puduncles and basal cistern will be visualised with its classic butterfly wing structure in the mesencephalic plane. The middle cerebral artery (MCA) will be accessed through the transtemporal window at a depth of 50-60 mm,Time of TCCD study and the blood pressure during the time of TCCD will be noted. In case of asymmetry of values on both sides, the side with higher value will be considered. A normal PI will be defined as value less than 1.2. ONSD will be measured by positioning the probe on the temporal area of the eyelid, oriented in such a way that it provides a view of the optic disc and the point where the optic nerve enters the eye. ONSD will be quantified at a location situated 3mm behind the retina. This measurement will be taken with the aid of an electronic calliper, ensuring that the measurement axis is perpendicular to the optic nerve. To enhance accuracy and minimize errors, the mean of three measurements will be derived for each eye from each patient. ONSD 5mm or above is considered abnormaL. Patients will be transferred for radiologic investigation once deemed to be stable by the treating physician. Rotterdam CT scoring and Marshall scoring will be done by the neurosurgeon who will be blinded for the TCCD findings. 

DATA

Patient demographics, referral details 

Vitals- non invasive blood pressure, heart rate, saturation on arrival till 30 mins 

Arterial blood gas

TCCD pulsatility index, ONSD , Rotterdam ct scoring, marshall ct scoring