EEG showed higher sensitivity (92%, 95% CI: 83–97) than TCD (79%, 95% CI: 71–85) for diagnosing delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage.
Do transcranial Doppler and electroencephalogram accurately diagnose delayed cerebral ischemia in adults with aneurysmal subarachnoid hemorrhage?
Both TCD and EEG demonstrate strong diagnostic accuracy for delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage, with EEG offering superior sensitivity and TCD providing balanced rule-in and rule-out performance.
ABSTRACT This review was done to assess the diagnostic accuracy of transcranial Doppler (TCD) or electroencephalogram (EEG) accuracy for delayed cerebral ischemia (DCI) in adults with aneurysmal subarachnoid hemorrhage. MEDLINE, Embase, Cochrane CENTRAL, Scopus, and Web of Science were searched from inception to April 2025. Two reviewers independently screened studies, extracted 2 × 2 diagnostic data, and assessed the risk of bias using QUADAS‐2. Pooled sensitivity, specificity, positive and negative likelihood ratios (LR + , LR − ), diagnostic odds ratios (DOR), and area under the hierarchical summary receiver‐operating characteristic curve (AUROC) were estimated via bivariate random‐effects models. Fifty‐two studies (38 TCD; 14 EEG), encompassing 1278 DCI‐positive and 3033 DCI‐negative assessments, met inclusion. For TCD, pooled sensitivity was 0.79 (95% CI: 0.71–0.85) and specificity 0.82 (0.75–0.87), with LR + 4.3 (3.1–6.1), LR − 0.26 (0.19–0.36), DOR 17 (9–31), and AUROC 0.87 (0.84–0.90). EEG yielded sensitivity 0.92 (0.83–0.97) and specificity 0.70 (0.58–0.80), with LR + 3.1 (2.1–4.6), LR − 0.11 (0.05–0.27), DOR 27 (9–83), and AUROC 0.89 (0.86–0.91). Deek's tests showed no publication bias. TCD and EEG both demonstrate strong diagnostic accuracy for DCI after aneurysmal subarachnoid hemorrhage. EEG offers superior sensitivity and rule‐out value, while TCD provides balanced rule‐in and rule‐out performance.
Chen et al. (2026) studied this question. EEG showed higher sensitivity (92%, 95% CI: 83–97) than TCD (79%, 95% CI: 71–85) for diagnosing delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage.