Transcranial Doppler velocimetry in aneurysmal subarachnoid haemorrhage: intra- and interobserver agreement and relation to angiographic vasospasm and mortality

TY - JOUR

T1 - Transcranial Doppler velocimetry in aneurysmal subarachnoid haemorrhage

T2 - intra- and interobserver agreement and relation to angiographic vasospasm and mortality

AU - Staalsø, J M

AU - Edsen, T

AU - Romner, B

AU - Olsen, Niels Vidiendal

PY - 2013/4

Y1 - 2013/4

N2 - BackgroundTranscranial Doppler measurements of the middle cerebral artery flow velocity are widely used as an indicator of vasospasm after aneurysmal subarachnoid haemorrhage (SAH). We investigated inter- and intraoperator agreement in SAH patients and healthy volunteers using colour-coded transcranial Doppler (TCCD), with the secondary aim of describing prediction of angiographic vasospasm and mortality.MethodsSixty patients and 70 healthy controls were each examined in duplicate by alternating operators. A total of 939 measurements divided on 201 examination sets were conducted by four observers. The Bland-Altman limits of agreement (LoA) were calculated using a variance components analysis. Angiography was performed on clinical indication and survival recorded at 30 days. Results Differences between measurements increased with increasing average, and therefore, we analysed log-transformed values. Thus, LoA are given as ratios between measurements. There were no systematic intra- or interobserver differences (bias). The intraobserver LoA was 0.62-1.61 in patients and 0.67-1.50 in controls. However, they were 0.55-1.82 in patients with angiographic vasospasm, whereas in patients without, they were 0.66-1.52. The interobserver LoA was 0.55-1.81 in patients and 0.65-1.55 in controls, while in patients with and without angiographic vasospasm, they were 0.45-2.22 and 0.60-1.67, respectively. Flow velocity measurements day 6-10 were positively associated with 30 day mortality risk (P=0.02, logistic regression). ConclusionsTCCD measurement variability is wider in patient measurements than in controls. This discrepancy can largely be explained by a higher degree of error in patients with angiographic vasospasm. Despite the considerable measurement variability in TCCD, values are predictive of outcome in SAH.

AB - BackgroundTranscranial Doppler measurements of the middle cerebral artery flow velocity are widely used as an indicator of vasospasm after aneurysmal subarachnoid haemorrhage (SAH). We investigated inter- and intraoperator agreement in SAH patients and healthy volunteers using colour-coded transcranial Doppler (TCCD), with the secondary aim of describing prediction of angiographic vasospasm and mortality.MethodsSixty patients and 70 healthy controls were each examined in duplicate by alternating operators. A total of 939 measurements divided on 201 examination sets were conducted by four observers. The Bland-Altman limits of agreement (LoA) were calculated using a variance components analysis. Angiography was performed on clinical indication and survival recorded at 30 days. Results Differences between measurements increased with increasing average, and therefore, we analysed log-transformed values. Thus, LoA are given as ratios between measurements. There were no systematic intra- or interobserver differences (bias). The intraobserver LoA was 0.62-1.61 in patients and 0.67-1.50 in controls. However, they were 0.55-1.82 in patients with angiographic vasospasm, whereas in patients without, they were 0.66-1.52. The interobserver LoA was 0.55-1.81 in patients and 0.65-1.55 in controls, while in patients with and without angiographic vasospasm, they were 0.45-2.22 and 0.60-1.67, respectively. Flow velocity measurements day 6-10 were positively associated with 30 day mortality risk (P=0.02, logistic regression). ConclusionsTCCD measurement variability is wider in patient measurements than in controls. This discrepancy can largely be explained by a higher degree of error in patients with angiographic vasospasm. Despite the considerable measurement variability in TCCD, values are predictive of outcome in SAH.

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Algorithms

KW - Angiography, Digital Subtraction

KW - Cerebral Angiography

KW - Cerebrovascular Circulation

KW - Female

KW - Forecasting

KW - Humans

KW - Male

KW - Middle Aged

KW - Middle Cerebral Artery

KW - Observer Variation

KW - Prospective Studies

KW - Subarachnoid Hemorrhage

KW - Tomography, X-Ray Computed

KW - Ultrasonography, Doppler, Transcranial

KW - Vasospasm, Intracranial

KW - Young Adult

U2 - 10.1093/bja/aes458

DO - 10.1093/bja/aes458

M3 - Journal article

C2 - 23257989

SN - 0007-0912

VL - 110

SP - 577

EP - 585

JO - British Journal of Anaesthesia

JF - British Journal of Anaesthesia

IS - 4

ER -