C. Filippini - Academia.edu (original) (raw)

Papers by C. Filippini

Research paper thumbnail of Doctor–couple communication during assisted reproductive technology visits

Human Reproduction, 2018

Physicians were mainly focused on providing biomedical information, while communication content f... more Physicians were mainly focused on providing biomedical information, while communication content from couples had a 2-fold focus on providing biomedical information and on positive talk. WHAT IS KNOWN ALREADY: Communication aspects in ART seem crucial for clinical decision-making, retention in care and critical conversations with couples due to low treatment success rates. However, no studies have been carried out on the actual interaction between the doctor and the couple in this context. STUDY DESIGN, SIZE, DURATION: This observational study involved 28 clinicians and 160 patients referred to eight Italian ART clinics during a one-year recruitment period. PARTICIPANTS/MATERIALS, SETTING, METHODS: ART visits at eight Italian clinics were videotaped. The visits were coded using the Roter Interaction Analysis System (RIAS), particularly focusing on RIAS composite categories, verbal dominance and patient-centeredness score. MAIN RESULTS AND THE ROLE OF CHANCE: A total of 85 visits were eligible for analysis (62% acceptance rate), involving 28 clinicians and 160 patients (including 75 couples). The average visit duration was 37 ± 17.7 min. The mean verbal dominance was 1.9 ± 0.86 (range: 0.72-5.74). Physicians mainly focused on providing biomedical information. Communication content from couples had a 2-fold focus on providing biomedical information and on positive talk. The mean of patient centeredness index (PCI) was 0.51 (SD = 0.28; range 0.08-1.77); visits in which the doctor was a woman or the treatment indication was for heterologous fertilization showed higher PCI scores. Overall, females accounted for 67% of all patient talk. Taking this imbalance into account as expected frequencies for each composite category, males reported significantly more utterances in almost all of the socioemotional categories. LIMITATIONS, REASONS FOR CAUTION: These results are preliminary and observational and only regard Italy. Communication during visits may have been biased since the professionals who agreed to participate showed an interest in communication issues. Another limitation is a possible Hawthorne effect due to the fact that participants were aware of being videotaped. WIDER IMPLICATIONS OF THE FINDINGS: Our study showed that ART physicians mainly adopted an informative model of communication and a more disease-oriented approach. Findings revealed the complexity of communication content during ART consultations, given † The authors consider that the first two authors should be regarded as joint first authors.

Research paper thumbnail of Neuroendocrine predictors of vasoplegia after cardiopulmonary bypass

Journal of Endocrinological Investigation, 2020

Purpose Vasoplegia often complicates on-pump cardiac surgery. Systemic inflammatory response indu... more Purpose Vasoplegia often complicates on-pump cardiac surgery. Systemic inflammatory response induced by extracorporeal circulation represents the major determinant, but adrenal insufficiency and postoperative vasopressin deficiency may have a role. Pathophysiological meaning of perioperative changes in endocrine markers of hydro-electrolyte balance has not still fully elucidated. Objectives of the present research study were to estimate the incidence of vasoplegia in a homogeneous cohort of not severe cardiopathic patients, to define the role of presurgical adrenal insufficiency, to evaluate copeptin and NT-proBNP trends in the perioperative. Methods We conducted a prospective cohort study in the cardiac intensive care unit of a tertiary referral center. We evaluated 350 consecutive patients scheduled for cardiac surgery; 55 subjects completed the study. Both standard and low-dose corticotropin stimulation tests were performed in the preoperative; copeptin and NT-proBNP were evaluat...

Research paper thumbnail of Prostate biopsies before pre-salvage radical prostatectomy: Do they rightly confirm the final histology?

European Urology Supplements, 2018

higher clinical Gleason grade groups compared to individual without BCR (p = 0.03). Between two g... more higher clinical Gleason grade groups compared to individual without BCR (p = 0.03). Between two group we did not found significant difference concerning preoperative characteristics. Table 2 shows the pathologic characteristics of our population. Overall 30 (24.8%), 59 (48.8%), 23 (19%) and 9 (7.4%) patients revealed pT2R1, pT3aR0, pT3a R1 and pT3bR0 disease, respectively. Lymphadenectomy was performed in the 76.6% of cases, all resulted as pN0. Patients with R1 were 46.3% (80% in cases with BCR and 43.1% in cases without BCR; p = 0.2). Considering R1 patients, a positive surgical margin ≥3 mm have been found in 44.7% of men without BCR and in 75% of patients with BCR (p = 0.2). The median (IQR) time to BCR was 8 (7-9) months. Out of 5 patients with BCR, 4 were submitted to early sRT (1 person refused the proposed treatment). The median (IQR) time of early sRT was 11 (9-13) months after RP (Table 3). The BCR free survival rate was 93.7% at 1 year (Figure 1). Discussion: Strict surveillance with PSA monitoring every two months during the first year after surgery and early detection of BCR can avoid aRT and spare sRT within 1 years follow up in a consistent proportion of PCa patients with intermediate-high risk of recurrence after RP. The survival benefit of such aggressive surveillance and modulated early sRT needs to be evaluated at longer follow up.

Research paper thumbnail of Salvage radical prostatectomy after biochemical recurrence of malignancy: A multicentre study of 18 tertiary referral centres

European Urology Supplements, 2018

sRP sample pathological stage was pT2 in 44.6%, pT3 in 53.9%. 5 sRP were not evaluable due to rad... more sRP sample pathological stage was pT2 in 44.6%, pT3 in 53.9%. 5 sRP were not evaluable due to radiation injury or had no tumour (pT0). 26 men did not undergo biopsy before sRP. Conc, UpGr and DownGr between cBx and sRP specimen were 63.7% (n = 202), 23% (n = 73) and 13.3% (n = 42); agreement was fair (k = 0.487). Conc, UpGr and DownGr between fBx and cBx were 36.3% (n = 102, 58.7% (n = 165) and 5% (n = 14); agreement was poor (k = 0.126). Conc, UpGr and DownGr between fBx and sRP specimen were 32.8% (n = 97), 63.2% (n = 187) and 4% (n = 12) respectively, also with poor agreement (k = 0.076). Discussion: Pre-sRP prostate biopsy is crucial in the diagnostic pathway in case of BCR after primary non-surgical treatment. However, it must be noted that in a considerable portion of cases was detected a higher GS at the final histology of the sRP specimen. The lone original diagnostic biopsy cannot be used to plan treatment in case of PCa recurrence for in more than half of the cases an upgrading is recorded. P253 Salvage radical prostatectomy after biochemical recurrence of malignancy: A multicentre study of 18 tertiary referral centres

Research paper thumbnail of MA20.07 Thymomectomy and Total Thymectomy or Simple Thymomectomy for Early Stage Thymoma Without Myasthenia Gravis: An ESTS Thymic Working Group Study

Journal of Thoracic Oncology, 2019

Research paper thumbnail of Early vs Late Tracheotomy for Prevention of Pneumonia in Mechanically Ventilated Adult ICU Patients

JAMA, 2010

RACHEOTOMY IS A SURGICAL procedure that is performed to replace endotracheal intubation in patien... more RACHEOTOMY IS A SURGICAL procedure that is performed to replace endotracheal intubation in patients who are expected to require prolonged mechanical ventilation. 1 Advantages of tracheotomy include prevention of ventilator-associated pneumonia (VAP), earlier weaning from respiratory support, and reduction in sedative use. 2-5 For editorial comment see p 1537.

Research paper thumbnail of ECMO criteria for influenza A (H1N1)-associated ARDS: role of transpulmonary pressure

Intensive Care Medicine, 2012

Research paper thumbnail of Factors affecting pattern of care and survival in a population-based cohort of non-small-cell lung cancer incident cases

Cancer Epidemiology, 2010

To analyze the role of sociodemographic factors as determinants of the initial pattern of care an... more To analyze the role of sociodemographic factors as determinants of the initial pattern of care and survival in incident NSCLC cases. We linked 2298 incident NSCLC cases, identified by the Piedmont Cancer Registry of Turin (PCRT) with administrative health records to identify the initial pattern of care. Because stage of disease strongly influences pattern of care and prognosis of NSCLC, all the analyses were stratified according to stage (early and advanced). The association between the set of patient's characteristics and the probability of accessing a specific pattern of care was analysed with a multivariable multinomial logistic regression model. Survival was analysed with the Cox proportional hazard model. In the early stage group, presence of comorbidities, older age and low educational level were all associated with a lower probability of receiving surgery. These same factors, as well as being unmarried, were associated with higher probability of receiving other non-curative care only. The effects of comorbidities and low educational level as barriers to receiving more effective patterns of care were not relevant in the advanced stage group. When controlling for initial patterns of care, in the early stage group, an age older than 75 years and being unmarried were negative prognostic factors, while survival was completely independent from educational level. Among patients with an advanced stage of disease, only comorbidities had a negative impact on survival. Appropriate lung cancer care is affected by sociodemographic factors. Greater attention to social and health programs is recommended to improve the timeliness of diagnosis, the staging of potentially resectable patients, and to implement more comprehensive multidisciplinary evaluations of those who may benefit from curative treatments.

Research paper thumbnail of Medium Term Outcomes of Transapical Aortic Valve Implantation: Results From the Italian Registry of Trans-Apical Aortic Valve Implantation

The Annals of Thoracic Surgery, 2013

Research paper thumbnail of Accuracy of Plateau Pressure and Stress Index to Identify Injurious Ventilation in Patients with Acute Respiratory Distress Syndrome

Anesthesiology, 2013

Background: Guidelines suggest a plateau pressure (Pplat) of 30 cm H2O or less for patients with ... more Background: Guidelines suggest a plateau pressure (Pplat) of 30 cm H2O or less for patients with acute respiratory distress syndrome, but ventilation may still be injurious despite adhering to this guideline. The shape of the curve plotting airway pressure versus time (StressIndex) may identify injurious ventilation. The authors assessed accuracy of Pplat and StressIndex to identify morphological indexes of injurious ventilation. Methods: Indexes of lung aeration (computerized tomography) associated with injurious ventilation were used as a “reference standard.” Threshold values of Pplat and StressIndex were determined assessing the receiver-operating characteristics (“training set,” N = 30). Accuracy of these values was assessed in a second group of patients (“validation set,” N = 20). Pplat and StressIndex were partitioned between respiratory system (Pplat,Rs and StressIndex,rs) and lung (Pplat,l and StressIndex,l; esophageal pressure; “physiological set,” N = 50). Results: Sensit...

Research paper thumbnail of COVID-19 and first trimester spontaneous abortion: a case-control study of 225 pregnant patients

ABSTRACTBackgroundEvidence for the impact of COVID-19 during the second and the third trimester o... more ABSTRACTBackgroundEvidence for the impact of COVID-19 during the second and the third trimester of pregnancy is limited to a relatively small series, while data on the first trimester are scant. With this study we evaluated COVID-19 infection as a risk factor for spontaneous abortion in first trimester of pregnancy.MethodsBetween February 22 and May 21, 2020, we conducted a case-control study at S. Anna Hospital, Turin, among first trimester pregnant women, paired for last menstruation. The cumulative incidence of COVID-19 was compared between women with spontaneous abortion (case group, n=100) and those with ongoing pregnancy (control group, n=125). Current or past infection was determined by detection of SARS-CoV-2 from nasopharingeal swab and SARS- CoV-2 IgG/IgM antibodies in blood sample. Patient demographics, COVID-19-related symptoms, and the main risk factors for abortion were collected.FindingsTwenty-three (10.2%) of the 225 women tested positive for COVID-19 infection. Ther...

Research paper thumbnail of A systematic review and individual participant data (IPD) meta-analysis of risk factors for anastomotic leak after rectal cancer surgery: the Syreal Study

Research paper thumbnail of The accuracy of transcranial Doppler to detect vasospasm in patients with aneurysmal subarachnoid hemorrhage

Intensive Care Medicine, 2003

Objectives: To examine the accuracy of transcranial Doppler to detect cerebral vasospasm in a pat... more Objectives: To examine the accuracy of transcranial Doppler to detect cerebral vasospasm in a patient population with aneurysmal subarachnoid hemorrhage. Design: Prospective blind comparison of transcranial Doppler with cerebral angiography. Diagnostic accuracy of transcranial Doppler was assessed using receiver operating characteristic (ROC) analysis and likelihood ratios. Sensitivity and specificity were calculated using directly measured middle cerebral artery diameter as reference standard. Setting: Intensive Care Unit of a large university teaching hospital. Patients and participants: Twenty-two patients with subarachnoid hemorrhage were included. Patients underwent angiography on admission and after 8 days to diagnose vasospasm and were defined as having clinical vasospasm, angiographic vasospasm, or no vasospasm. Measurements and results: Sensitivity and specificity were 1.00 and 0.75 for angiographic vasospasm and both equal to 1.00 for clinical vasospasm diagnosis. A transcranial Doppler mean velocity threshold value of 100 cm/s for angiographic vasospasm and 160 cm/s for clinical vasospasm detection were chosen by ROC analysis. Conclusions: A Transcranial Doppler mean velocity threshold of 160 cm/s, calculated by the ROC analysis, accurately detects clinical vasospasm. A daily transcranial Doppler examination performed by a trained operator should be routinely used to provide early identification of patients at high risk and to orient therapeutic decisions.

Research paper thumbnail of Doctor–couple communication during assisted reproductive technology visits

Human Reproduction, 2018

Physicians were mainly focused on providing biomedical information, while communication content f... more Physicians were mainly focused on providing biomedical information, while communication content from couples had a 2-fold focus on providing biomedical information and on positive talk. WHAT IS KNOWN ALREADY: Communication aspects in ART seem crucial for clinical decision-making, retention in care and critical conversations with couples due to low treatment success rates. However, no studies have been carried out on the actual interaction between the doctor and the couple in this context. STUDY DESIGN, SIZE, DURATION: This observational study involved 28 clinicians and 160 patients referred to eight Italian ART clinics during a one-year recruitment period. PARTICIPANTS/MATERIALS, SETTING, METHODS: ART visits at eight Italian clinics were videotaped. The visits were coded using the Roter Interaction Analysis System (RIAS), particularly focusing on RIAS composite categories, verbal dominance and patient-centeredness score. MAIN RESULTS AND THE ROLE OF CHANCE: A total of 85 visits were eligible for analysis (62% acceptance rate), involving 28 clinicians and 160 patients (including 75 couples). The average visit duration was 37 ± 17.7 min. The mean verbal dominance was 1.9 ± 0.86 (range: 0.72-5.74). Physicians mainly focused on providing biomedical information. Communication content from couples had a 2-fold focus on providing biomedical information and on positive talk. The mean of patient centeredness index (PCI) was 0.51 (SD = 0.28; range 0.08-1.77); visits in which the doctor was a woman or the treatment indication was for heterologous fertilization showed higher PCI scores. Overall, females accounted for 67% of all patient talk. Taking this imbalance into account as expected frequencies for each composite category, males reported significantly more utterances in almost all of the socioemotional categories. LIMITATIONS, REASONS FOR CAUTION: These results are preliminary and observational and only regard Italy. Communication during visits may have been biased since the professionals who agreed to participate showed an interest in communication issues. Another limitation is a possible Hawthorne effect due to the fact that participants were aware of being videotaped. WIDER IMPLICATIONS OF THE FINDINGS: Our study showed that ART physicians mainly adopted an informative model of communication and a more disease-oriented approach. Findings revealed the complexity of communication content during ART consultations, given † The authors consider that the first two authors should be regarded as joint first authors.

Research paper thumbnail of Neuroendocrine predictors of vasoplegia after cardiopulmonary bypass

Journal of Endocrinological Investigation, 2020

Purpose Vasoplegia often complicates on-pump cardiac surgery. Systemic inflammatory response indu... more Purpose Vasoplegia often complicates on-pump cardiac surgery. Systemic inflammatory response induced by extracorporeal circulation represents the major determinant, but adrenal insufficiency and postoperative vasopressin deficiency may have a role. Pathophysiological meaning of perioperative changes in endocrine markers of hydro-electrolyte balance has not still fully elucidated. Objectives of the present research study were to estimate the incidence of vasoplegia in a homogeneous cohort of not severe cardiopathic patients, to define the role of presurgical adrenal insufficiency, to evaluate copeptin and NT-proBNP trends in the perioperative. Methods We conducted a prospective cohort study in the cardiac intensive care unit of a tertiary referral center. We evaluated 350 consecutive patients scheduled for cardiac surgery; 55 subjects completed the study. Both standard and low-dose corticotropin stimulation tests were performed in the preoperative; copeptin and NT-proBNP were evaluat...

Research paper thumbnail of Prostate biopsies before pre-salvage radical prostatectomy: Do they rightly confirm the final histology?

European Urology Supplements, 2018

higher clinical Gleason grade groups compared to individual without BCR (p = 0.03). Between two g... more higher clinical Gleason grade groups compared to individual without BCR (p = 0.03). Between two group we did not found significant difference concerning preoperative characteristics. Table 2 shows the pathologic characteristics of our population. Overall 30 (24.8%), 59 (48.8%), 23 (19%) and 9 (7.4%) patients revealed pT2R1, pT3aR0, pT3a R1 and pT3bR0 disease, respectively. Lymphadenectomy was performed in the 76.6% of cases, all resulted as pN0. Patients with R1 were 46.3% (80% in cases with BCR and 43.1% in cases without BCR; p = 0.2). Considering R1 patients, a positive surgical margin ≥3 mm have been found in 44.7% of men without BCR and in 75% of patients with BCR (p = 0.2). The median (IQR) time to BCR was 8 (7-9) months. Out of 5 patients with BCR, 4 were submitted to early sRT (1 person refused the proposed treatment). The median (IQR) time of early sRT was 11 (9-13) months after RP (Table 3). The BCR free survival rate was 93.7% at 1 year (Figure 1). Discussion: Strict surveillance with PSA monitoring every two months during the first year after surgery and early detection of BCR can avoid aRT and spare sRT within 1 years follow up in a consistent proportion of PCa patients with intermediate-high risk of recurrence after RP. The survival benefit of such aggressive surveillance and modulated early sRT needs to be evaluated at longer follow up.

Research paper thumbnail of Salvage radical prostatectomy after biochemical recurrence of malignancy: A multicentre study of 18 tertiary referral centres

European Urology Supplements, 2018

sRP sample pathological stage was pT2 in 44.6%, pT3 in 53.9%. 5 sRP were not evaluable due to rad... more sRP sample pathological stage was pT2 in 44.6%, pT3 in 53.9%. 5 sRP were not evaluable due to radiation injury or had no tumour (pT0). 26 men did not undergo biopsy before sRP. Conc, UpGr and DownGr between cBx and sRP specimen were 63.7% (n = 202), 23% (n = 73) and 13.3% (n = 42); agreement was fair (k = 0.487). Conc, UpGr and DownGr between fBx and cBx were 36.3% (n = 102, 58.7% (n = 165) and 5% (n = 14); agreement was poor (k = 0.126). Conc, UpGr and DownGr between fBx and sRP specimen were 32.8% (n = 97), 63.2% (n = 187) and 4% (n = 12) respectively, also with poor agreement (k = 0.076). Discussion: Pre-sRP prostate biopsy is crucial in the diagnostic pathway in case of BCR after primary non-surgical treatment. However, it must be noted that in a considerable portion of cases was detected a higher GS at the final histology of the sRP specimen. The lone original diagnostic biopsy cannot be used to plan treatment in case of PCa recurrence for in more than half of the cases an upgrading is recorded. P253 Salvage radical prostatectomy after biochemical recurrence of malignancy: A multicentre study of 18 tertiary referral centres

Research paper thumbnail of MA20.07 Thymomectomy and Total Thymectomy or Simple Thymomectomy for Early Stage Thymoma Without Myasthenia Gravis: An ESTS Thymic Working Group Study

Journal of Thoracic Oncology, 2019

Research paper thumbnail of Early vs Late Tracheotomy for Prevention of Pneumonia in Mechanically Ventilated Adult ICU Patients

JAMA, 2010

RACHEOTOMY IS A SURGICAL procedure that is performed to replace endotracheal intubation in patien... more RACHEOTOMY IS A SURGICAL procedure that is performed to replace endotracheal intubation in patients who are expected to require prolonged mechanical ventilation. 1 Advantages of tracheotomy include prevention of ventilator-associated pneumonia (VAP), earlier weaning from respiratory support, and reduction in sedative use. 2-5 For editorial comment see p 1537.

Research paper thumbnail of ECMO criteria for influenza A (H1N1)-associated ARDS: role of transpulmonary pressure

Intensive Care Medicine, 2012

Research paper thumbnail of Factors affecting pattern of care and survival in a population-based cohort of non-small-cell lung cancer incident cases

Cancer Epidemiology, 2010

To analyze the role of sociodemographic factors as determinants of the initial pattern of care an... more To analyze the role of sociodemographic factors as determinants of the initial pattern of care and survival in incident NSCLC cases. We linked 2298 incident NSCLC cases, identified by the Piedmont Cancer Registry of Turin (PCRT) with administrative health records to identify the initial pattern of care. Because stage of disease strongly influences pattern of care and prognosis of NSCLC, all the analyses were stratified according to stage (early and advanced). The association between the set of patient's characteristics and the probability of accessing a specific pattern of care was analysed with a multivariable multinomial logistic regression model. Survival was analysed with the Cox proportional hazard model. In the early stage group, presence of comorbidities, older age and low educational level were all associated with a lower probability of receiving surgery. These same factors, as well as being unmarried, were associated with higher probability of receiving other non-curative care only. The effects of comorbidities and low educational level as barriers to receiving more effective patterns of care were not relevant in the advanced stage group. When controlling for initial patterns of care, in the early stage group, an age older than 75 years and being unmarried were negative prognostic factors, while survival was completely independent from educational level. Among patients with an advanced stage of disease, only comorbidities had a negative impact on survival. Appropriate lung cancer care is affected by sociodemographic factors. Greater attention to social and health programs is recommended to improve the timeliness of diagnosis, the staging of potentially resectable patients, and to implement more comprehensive multidisciplinary evaluations of those who may benefit from curative treatments.

Research paper thumbnail of Medium Term Outcomes of Transapical Aortic Valve Implantation: Results From the Italian Registry of Trans-Apical Aortic Valve Implantation

The Annals of Thoracic Surgery, 2013

Research paper thumbnail of Accuracy of Plateau Pressure and Stress Index to Identify Injurious Ventilation in Patients with Acute Respiratory Distress Syndrome

Anesthesiology, 2013

Background: Guidelines suggest a plateau pressure (Pplat) of 30 cm H2O or less for patients with ... more Background: Guidelines suggest a plateau pressure (Pplat) of 30 cm H2O or less for patients with acute respiratory distress syndrome, but ventilation may still be injurious despite adhering to this guideline. The shape of the curve plotting airway pressure versus time (StressIndex) may identify injurious ventilation. The authors assessed accuracy of Pplat and StressIndex to identify morphological indexes of injurious ventilation. Methods: Indexes of lung aeration (computerized tomography) associated with injurious ventilation were used as a “reference standard.” Threshold values of Pplat and StressIndex were determined assessing the receiver-operating characteristics (“training set,” N = 30). Accuracy of these values was assessed in a second group of patients (“validation set,” N = 20). Pplat and StressIndex were partitioned between respiratory system (Pplat,Rs and StressIndex,rs) and lung (Pplat,l and StressIndex,l; esophageal pressure; “physiological set,” N = 50). Results: Sensit...

Research paper thumbnail of COVID-19 and first trimester spontaneous abortion: a case-control study of 225 pregnant patients

ABSTRACTBackgroundEvidence for the impact of COVID-19 during the second and the third trimester o... more ABSTRACTBackgroundEvidence for the impact of COVID-19 during the second and the third trimester of pregnancy is limited to a relatively small series, while data on the first trimester are scant. With this study we evaluated COVID-19 infection as a risk factor for spontaneous abortion in first trimester of pregnancy.MethodsBetween February 22 and May 21, 2020, we conducted a case-control study at S. Anna Hospital, Turin, among first trimester pregnant women, paired for last menstruation. The cumulative incidence of COVID-19 was compared between women with spontaneous abortion (case group, n=100) and those with ongoing pregnancy (control group, n=125). Current or past infection was determined by detection of SARS-CoV-2 from nasopharingeal swab and SARS- CoV-2 IgG/IgM antibodies in blood sample. Patient demographics, COVID-19-related symptoms, and the main risk factors for abortion were collected.FindingsTwenty-three (10.2%) of the 225 women tested positive for COVID-19 infection. Ther...

Research paper thumbnail of A systematic review and individual participant data (IPD) meta-analysis of risk factors for anastomotic leak after rectal cancer surgery: the Syreal Study

Research paper thumbnail of The accuracy of transcranial Doppler to detect vasospasm in patients with aneurysmal subarachnoid hemorrhage

Intensive Care Medicine, 2003

Objectives: To examine the accuracy of transcranial Doppler to detect cerebral vasospasm in a pat... more Objectives: To examine the accuracy of transcranial Doppler to detect cerebral vasospasm in a patient population with aneurysmal subarachnoid hemorrhage. Design: Prospective blind comparison of transcranial Doppler with cerebral angiography. Diagnostic accuracy of transcranial Doppler was assessed using receiver operating characteristic (ROC) analysis and likelihood ratios. Sensitivity and specificity were calculated using directly measured middle cerebral artery diameter as reference standard. Setting: Intensive Care Unit of a large university teaching hospital. Patients and participants: Twenty-two patients with subarachnoid hemorrhage were included. Patients underwent angiography on admission and after 8 days to diagnose vasospasm and were defined as having clinical vasospasm, angiographic vasospasm, or no vasospasm. Measurements and results: Sensitivity and specificity were 1.00 and 0.75 for angiographic vasospasm and both equal to 1.00 for clinical vasospasm diagnosis. A transcranial Doppler mean velocity threshold value of 100 cm/s for angiographic vasospasm and 160 cm/s for clinical vasospasm detection were chosen by ROC analysis. Conclusions: A Transcranial Doppler mean velocity threshold of 160 cm/s, calculated by the ROC analysis, accurately detects clinical vasospasm. A daily transcranial Doppler examination performed by a trained operator should be routinely used to provide early identification of patients at high risk and to orient therapeutic decisions.