2015/10/24 by Gyanendra Kumar, Reza Bavarsad Shahripour, Mark R. Harrigan · 225 citations
Medicine · #Anesthesia #Cardiology #Cerebral vasospasm #Cerebrovascular and Carotid Artery Diseases #Confidence interval #Internal medicine #Intracranial Aneurysms: Treatment and Complications #Medicine #Meta-analysis #Subarachnoid hemorrhage #Transcranial Doppler #Traumatic Brain Injury and Neurovascular Disturbances #Vasospasm
paper · pdf · doi:10.3171/2015.4.jns15428
published in Journal of neurosurgery 124(5), 1257-1264 (American Association of Neurological Surgeons)
openalex publication_date 2015/10/24 · openalex created_date 2025/10/10 · openalex updated_date 2026/08/04
OBJECT The impact of transcranial Doppler (TCD) ultrasonography evidence of vasospasm on patient-centered clinical outcomes following aneurysmal subarachnoid hemorrhage (aSAH) is unknown. Vasospasm is known to lead to delayed cerebral ischemia (DCI) and poor outcomes. This systematic review and meta-analysis evaluates the predictive value of vasospasm on DCI, as diagnosed on TCD. METHODS MEDLINE, Scopus, the Cochrane trial register, and clinicaltrials.gov were searched through September 2014 using key words and the terms "subarachnoid hemorrhage," "aneurysm," "aneurysmal," "cerebral vasospasm," "vasospasm," "transcranial Doppler," and "TCD." Sensitivities, specificities, and positive and negative predictive values were pooled by a DerSimonian and Laird random-effects model. RESULTS Seventeen studies (n = 2870 patients) met inclusion criteria. The amount of variance attributable to heterogeneity was significant (I(2) > 50%) for all syntheses. No studies reported the impact of TCD evidence of vasospasm on functional outcome or mortality. TCD evidence of vasospasm was found to be highly predictive of DCI. Pooled estimates for TCD diagnosis of vasospasm (for DCI) were sensitivity 90% (95% confidence interval [CI] 77%-96%), specificity 71% (95% CI 51%-84%), positive predictive value 57% (95% CI 38%-71%), and negative predictive value 92% (95% CI 83%-96%). CONCLUSIONS TCD evidence of vasospasm is predictive of DCI with high accuracy. Although high sensitivity and negative predictive value make TCD an ideal monitoring device, it is not a mandated standard of care in aSAH due to the paucity of evidence on clinically relevant outcomes, despite recommendation by national guidelines. High-quality randomized trials evaluating the impact of TCD monitoring on patient-centered and physician-relevant outcomes are needed.