Background: Raised intracranial pressure(ICP) leads to change in the pulsatility index(PI) and resistive index(RI) of middle cerebral artery(MCA).

Aims: To compare the diagnostic accuracy of MCA flow indices by transcranial doppler(TCD) with invasive intra parenchymal pressure assessment in children with raised ICP.

Methodology: A blinded, observational study of all children(2-12 years) admitted to PICU undergoing ICP monitoring using intra parenchymal catheter was conducted from November 2016 to December 2017. MCA flow indices(PI and RI) were measured bilaterally and average calculated. Repeated measurements were taken at least 3 hours apart. Observations with a parallel measured ICP ≥20mmHg were included as case-observations(CObs). Children with invasive ICP of ≤15mmHg were taken as neurological-control-observations(NCObs) and healthy children served as healthy-control-observations(HCObs). Interrater reliability was assessed by two different observers in 10%.

Results: A total of 148 observations were performed in 30 children. Out of the 148 observations, 103 observations were CObs, 36 were NCObs. An additional, 66 observations were HCObs. For ICP ≥ 20 mmHg, the area under the curve for PI cut off of 0.51; RI cut off of 0.51 were 0.571; 0.579 respectively.  PI value of 0.51 for detection of ICP ≥20mmHg had Sensitivity and Specificity of 89% and 10% respectively. The kendall’s correlation coefficient between PI, RI and ICP was 0.148 and 0.147. Interclass correlation coefficient between two observers for PI and RI was 0.90 and 0.81 respectively.

Conclusions: TCD has a good interrater reliability but did not appear to have a good accuracy in the assessment of ICP.