Abstract
Objective: To assess the effect of hyperosmolar solutions on brain midline shift (MLS) using transcranial ultrasonography in patients with severe traumatic brain injury (TBI).
Design: A prospective observational study.
Setting: Critical Care Medicine Units at Kafr El-Dawar General Hospital, Beheira Health Directorate.
Patients and participants: A total of 55 patients with severe TBI (Glasgow Coma Scale [GCS] score of 3-8) and evidence of MLS on brain computed tomography (CT) were enrolled. Patients with brain midline shift due to other causes, end-stage renal disease requiring hemodialysis, hypernatremia (serum Na≥150 mEq/l), clinical signs of brain death, or age below 18 years were excluded.
Interventions: MLS was measured using transcranial sonography at admission and repeated 48 hours after administering hyperosmolar solutions. The results were compared with brain CT findings obtained at the same time points using two measurement methods.
Measurements and results: The negative difference in MLS between ultrasound (U/S) and CT method I showed a mean positive predictive value (PPV) of 75% and a mean negative predictive value (NPV) of 90.32%. The sensitivity of CT in diagnosing MLS using method I was 85.71%, while the specificity was 82.35%. In comparison, the negative difference in MLS between U/S and CT method II demonstrated a mean PPV of 83.33% and a mean NPV of 77.42%. The sensitivity of CT in diagnosing MLS using method II was 74.07%, while the specificity was 85.71%.
Conclusions: Ultrasonography provides comparable accuracy to CT in diagnosing midline shift in severe TBI patients. However, it offers advantages such as reduced radiation exposure and minimized patient transport burden, making it a safer and more accessible alternative in critical care settings.
Abd El Aziz Sabbah, Ahmed Nabil, Ahmed Taher, Tarek El Gohary
