Brain Damage
Conditions
Keywords
transcranial doppler, learning curve, emergency, traumatic brain injury
Brief summary
Transcranial Doppler is a noninvasive tool. Using velocity measurements and pulsatility index it allows the evaluation of cerebral haemodynamics. In patients presenting brain injury cerebral perfusion may be impaired. Indirect cerebral blood flow can be monitored and risk of neurological worsening can be detected using transcranial Doppler. Education and performance of emergency physicians must be evaluated on brain-injured patients because this tool is operator dependent. The main objective of this study is to estimate the average number of exams required to learn transcranial Doppler within junior emergency physicians with the achievement of their learning curve. We will perform a prospective, monocentric, observational study within the neurosurgical resuscitation department of Grenoble Alpes University Hospital.
Detailed description
The transcranial dopplers will be carry out on 75 brain-damaged patients by 13 emergency residents physicians after a theoretical and practical training. They will be evaluated by 8 experts. The primary endpoint will be the mean number of transcranial dopplers required to have an excellent concordance between resident and expert. The concordance between the Doppler findings of the resident and the expert would exceed 0.8 before 30 examinations. The learning curve assessed on the duration necessary to acquire good quality data should decrease rapidly with the repetition of the examinations. Validating the transcranial Doppler learning curve for junior emergency physician would allow them to perform this exam safely and efficiently. Transcranial Doppler may be easy and fast to learn but the persistence of its competency over time should be evaluated.
Interventions
None listed
Sponsors
University Hospital, Grenoble
Study design
Observational model
OTHER
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to 100 Years
Healthy volunteers
No
Inclusion criteria
* Adult patients : ≥ 18 year and older * Hospitalized in the neurosurgical resuscitation or intensive care unit * Brain - damaged patients
Exclusion criteria
* Any craniotemporal lesion impeding satisfactory TDC examination : no transtemporal doppler window, patient with craniectomy. * Patient with meningo-encephalitis * Patient with cerebral vasculitis * Patient without health insurance coverage * Patient subject to a legal protection measure * Pregnant woman , parturient or nursing
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| The mean number of transcranial doppler required to reach a kappa over 0,8 between the conclusions of the resident and expert. | 3 months | Learning curve |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Duration in seconds for the junior to achieve the transcranial doppler | 3 months | Time between the beginning of the exam (ultrasound probe caring) to the velocities and pulsatility index measurements |
| Analysis of the spectral envelope quality | 3 months | analysis of the plot of spectral envelope: good or bad |
| Analysis of the evolution of the estimated difficulty of transcranial doppler realization | 3 months | evaluation of the difficulty of transcranial doppler realization: easy or difficult |
| Analysis of the failure to perform the transcranial doppler | 10 minutes | number of failures to perform the transcranial doppler after 10 minutes |
| Analysis of the diastolic velocities and pulsatility index concordance between junior and expert | 3 months | number of examen required for junior velocities measurement to reach those of the expert |
Countries
France
Outcome results
None listed