Gayatri Lekshmi Madhavan
VIMS Hospital, India
Title: Point-of-care transcranial sonography for detection of midline shift in Neuro-emergencies in the emergency department
Biography
Biography: Gayatri Lekshmi Madhavan
Abstract
Introduction: Midline shift (MLS) in the brain is a life-threatening emergency, which requires immediate intervention following prompt diagnosis. Currently, CT brain is accepted as the gold standard in detection of MLS. Frequent CT is not possible due to various factors like radiation exposure, transport difficulties, unavailability of bedside CT in most hospitals, and challenges in the micro-economics. This has led to a constant endeavour to identify and develop other methods for detection of MLS, among which Transcranial Sonography (TCS) is included.
Objective: The objective of the study is to validate point-of-care TCS for detection of MLS in neuro-emergency patients in the Emergency Department, and compare it to CT values of MLS.
Methodology: This prospective double-blinded study was conducted from March 2018 to October 2018 in the Emergency Department of VIMS Hospital, Salem. All patients who required a CT brain were included, and a TCS was performed. MLS on TCS was calculated by measuring the distance between the outer table of the skull and the third ventricle on both sides, through the temporal window using a 2.8 MHz Sector Probe. TCS was done by a trained Emergency Physician who was unaware of the patient’s clinical status, prior to doing CT brain. CT report was obtained, and another Emergency Physician who was blinded to the patient’s status compared both values. MLS on CT was defined as the difference between the ideal midline and the septum pellucidum.
Observations: A total of 87 patients were included in this study. The MLS (mean±SD) was 0.21cm±0.31cm using TCS, and 0.20cm±0.34cm using CT. The Pearson’s and Spearman’s correlation co-efficient between CT and TCS was 0.971 and 0.87 respectively (p<0.01). The area under the ROC curve for detection of a significant MLS using TLS was 83.7%. Using 0.5cm as a cut-off (significant MLS), the sensitivity, specificity and positive likelihood ratio were 86.7%, 98.6% and 61.92 respectively.
Conclusion: This study concludes that Transcranial Sonography could detect Midline Shift with a reasonable accuracy, and can be used as a point-of-care tool in the Emergency Department to facilitate early diagnosis of MLS and intervene accordingly in neuro-emergencies.