# Improving Patient Safety in Subarachnoid Hemorrhage Using Transcranial Doppler (TCD) Simulation for Bedside Diagnosis of Cerebral Vasospasm

> **NIH AHRQ R18** · UNIVERSITY OF WASHINGTON · 2022 · $380,056

## Abstract

The goal of this research is to improve the safety of patients who suffer aneurysmal
subarachnoid hemorrhage (aSAH) by improving their access to recommended transcranial
Doppler (TCD) monitoring for cerebral vasospasm, a complication that affects 30-70% of aSAH
patients and leads to death in nearly half. Other diagnostic modalities are impractical for serial
monitoring due to expense, radiation exposure and logistics whereas TCD can be performed at
the patient’s bedside. TCD is recommended by 5 professional societies for monitoring cerebral
vasospasm yet is grossly underused nationally. The problem we address is the scarcity of
trained providers: there just 82 laboratories accreditated by the Intersocietal Accreditation
Commission (IAC) Vascular Testing to perform TCD.
We propose a TCD simulator that can be applied for both training and competency testing. Our
rationale is that training more providers and helping them to maintain skill will improve patient
access to this recommended diagnostic procedure; studies show that ultrasound simulators can
meet these needs. To develop the proposed simulator, we will leverage a prototype TCD
simulator that we are currently developing (MH115883) and test its performance.
Aim #1: We will complete the development of a simulator for training and skill assessment in
performing TCD examination for cerebral vasospasm. A Case Library will be created with 24
cases reflecting a range of disease severity, each prepared from actual patient data. We will
verify the accuracy of the simulation by comparing the blood flow velocity measured from the
simulator waveforms with the true velocities in the 3D models. We will verify the simulator’s
clinical realism by comparing spectral Doppler waveforms captured on the simulator with patient
waveforms recorded by expert sonologists.
Aim #2: We will create a curriculum for teaching TCD examination for cerebral vasospasm and
implement metrics of skill based on systematic insonation and the velocities measured. We will
assess the efficacy of the curriculum and the validity of the skill metrics.
Aim #3: We will verify the clinical validity of the simulator by randomizing trainees to simulator-
based vs. standard training and comparing the post-training skill in performing TCD examination
for cerebral vasospasm.
HEALTH CARE BENEFIT: The proposed research will improve patient safety by improved,
evidence-based utilization of TCD to diagnose cerebral vasospasm, eventually reducing
morbidity and mortality.

## Key facts

- **NIH application ID:** 10454128
- **Project number:** 5R18HS026690-04
- **Recipient organization:** UNIVERSITY OF WASHINGTON
- **Principal Investigator:** Deepak Sharma
- **Activity code:** R18 (R01, R21, SBIR, etc.)
- **Funding institute:** AHRQ
- **Fiscal year:** 2022
- **Award amount:** $380,056
- **Award type:** 5
- **Project period:** 2019-08-01 → 2025-01-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10454128

## Citation

> US National Institutes of Health, RePORTER application 10454128, Improving Patient Safety in Subarachnoid Hemorrhage Using Transcranial Doppler (TCD) Simulation for Bedside Diagnosis of Cerebral Vasospasm (5R18HS026690-04). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/10454128. Licensed CC0.

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