Transcranial Doppler in the Diagnosis of Cerebral Vasospasm: An Updated Meta-Analysis

Objectives: To evaluate the performance of transcranial Doppler and transcranial color-coded duplex Doppler in patients with cerebral vasospasm due to aneurysm rupture. Angiography was considered as the gold standard comparator. Data Sources: Search in MEDLINE, Embase, and Central from January 2001 to October 2017, without language restriction. Bibliographies of retrieved articles were screened for additional studies. Study Selection: Randomized studies comparing transcranial Doppler or transcranial color-coded duplex Doppler with angiography in adults. Data Extraction: Data were extracted independently by several investigators. Sensitivity and specificity were combined across studies using a bivariate model. Preferred Reporting Items for Systematic Reviews and Meta-Analyses was used for reporting and Quality Assessment of Diagnostic Accuracy Studies-2 for quality assessment. Data Synthesis: We included 18 studies. Fifteen tested transcranial Doppler. For the middle cerebral artery (10 studies, 1,408 tests), the pooled sensitivity was 66.7% (95% CI, 55.9–75.9) and specificity was 89.5% (80.3–94.7). Three studies (278 tests) tested transcranial color-coded duplex Doppler for the middle cerebral artery. The pooled sensitivity was 81.5% (66.0–90.0), and specificity was 96.6% (93.0–98.0). For an arbitrarily chosen prevalence of vasospasm of 70%, positive and negative predictive values were 93.7% (88.9–96.6) and 53.4% (46.7–60.9) for transcranial Doppler and 98.2% (96.4–99.1) and 69.1% (56.1–80.9) for transcranial color-coded duplex Doppler. Conclusions: Assuming a high prevalence of vasospasm of the middle cerebral artery, both transcranial Doppler and transcranial color-coded duplex Doppler are likely to detect it, but neither is useful to exclude it. There is no convincing evidence that the accuracy of transcranial color-coded duplex Doppler is any better than that of transcranial Doppler. For arteries other than middle cerebral artery, there is a lack of evidence of the usefulness of transcranial Doppler. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (https://ift.tt/29S62lw). Dr. Elia received funding from the European Journal of Anaesthesiology (methods editor). The remaining authors have disclosed that they do not have any potential conflicts of interest. For information regarding this article, E-mail: christopher.lysakowski@hcuge.ch Copyright © by 2018 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

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