Rodríguez VML, Godínez GF, Gómez GN, Jiménez CC, González CPL

Language: Spanish
References: 20
Page: 490-496
PDF size: 286.78 Kb.

ABSTRACT

Introduction: subarachnoid hemorrhage (SAH) is considered one of the most relevant neurological pathologies and represents 5% of cerebrovascular disease. Moreover, its complications, such as vasospasm, are considered the most important determinant of morbidity following SAH. Transcranial Doppler (TCD) is useful for its monitoring and early detection, however, because it is an operator-dependent study method, it is important to identify the concordance between measurements performed by physicians in training vs. specialists trained in the area. Objective: to determine the concordance in the detection of vasospasm by transcranial Doppler ultrasound between residents and specialists in critical care medicine. Material and methods: concordance study, observational, longitudinal, analytical. Two groups were compared: first and second year residents in the specialty of critical care medicine versus specialists (already qualified) both with training acquired during their training. Both groups performed a measurement in patients admitted to Intensive Care Unit (ICU) in the period from January to September 2024 with a diagnosis of aneurysmal subarachnoid hemorrhage. Through a non-probabilistic sampling by convenience, a total of 15 patients were included and 30 physicians participated (15 in each group). A correlation analysis was performed between the TCD measurements obtained and a concordance analysis for both groups. Results: the Lindegaard index obtained from TCD was used and compared with the result of cerebral angiography (used as the gold standard for the detection of vasospasm) with a CCI 0.714 CI 95% 0. 410-0.863 (p < 0.000), and a correlation of r = 0.603 (p < 0.0001) for the right middle cerebral artery (MCA) and CCI 0.899 CI 95% 0.790-0.952 (p < 0.0001), and correlation of r = 0.848 (p < 0.0001) for the left MCA. In addition, secondarily a Kappa coefficient was obtained the concordance observed in the detection of intracranial hypertension (ICH) between the measurement of the optic nerve sheath (ONV) by TCD and ONV by cranial angio-TAC for resident physicians of 0.675 (p < 0.0001) and for specialist physicians of 0.459 (p = 0.011). Conclusions: concordance was found for the diagnosis of vasospasm between measurements obtained by specialist and resident physicians by TCD compared to cerebral angiography. No significant difference was found between the two groups.

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