Admission Perfusion CT for Classifying Early In-Hospital Mortality of Patients With Severe Traumatic Brain Injury: A Pilot Study

Shankar, Jai; Green, Rob; Virani, Karim; Wong, Helen; Eddy, Katie; Vandorpe, Robert

doi:10.2214/ajr.19.21599

Cited by 13 publications

(16 citation statements)

References 20 publications

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“…Despite over a decade of research on CTP in the STBI population, there is still a paucity of studies with relatively small sample sizes. Several studies have investigated the potential uses for CTP in quantifying cerebral perfusion abnormalities in STBI [ 10 , 11 , 12 , 13 ], as well as changes after treatment [ 14 , 15 , 16 , 17 ] and prognostication [ 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 ]. This information may be helpful to guide the selection of patients for invasive ICP monitoring.…”

Section: Discussionmentioning

confidence: 99%

“…Abnormalities on CTP have also been shown to correlate with abnormalities in CPP and loss of cerebral autoregulation [ 10 , 11 , 12 , 13 ]. Several small studies have used CTP to investigate the cerebral blood flow changes after intervention for ICH in humans [ 14 , 15 , 16 ], and in animal models [ 17 ], CTP has been shown to predict short- and long-term functional outcomes in both mild and severe traumatic brain injury [ 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 ].…”

Section: Introductionmentioning

confidence: 99%

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Abnormalities on Perfusion CT and Intervention for Intracranial Hypertension in Severe Traumatic Brain Injury

Cooper

Bendinelli

Bivard

et al. 2020

JCM

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The role of invasive intracranial pressure (ICP) monitoring in patients with severe traumatic brain injury (STBI) remain unclear. Perfusion computed tomography (CTP) provides crucial information about the cerebral perfusion status in these patients. We hypothesised that CTP abnormalities would be associated with the severity of intracranial hypertension (ICH). To investigate this hypothesis, twenty-eight patients with STBI and ICP monitors were investigated with CTP within 48 h from admission. Treating teams were blind to these results. Patients were divided into five groups based on increasing intervention required to control ICH and were compared. Group I required no intervention above routine sedation, group II required a single first tier intervention, group III required multiple different first-tier interventions, group IV required second-tier medical therapy and group V required second-tier surgical therapy. Analysis of the results showed demographics and injury severity did not differ among groups. In group I no patients showed CTP abnormality, while patients in all other groups had abnormal CTP (p = 0.003). Severe ischaemia observed on CTP was associated with increasing intervention for ICH. This study, although limited by small sample size, suggests that CTP abnormalities are associated with the need to intervene for ICH. Larger scale assessment of our results is warranted to potentially avoid unnecessary invasive procedures in head injury patients.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Abnormalities on Perfusion CT and Intervention for Intracranial Hypertension in Severe Traumatic Brain Injury

Cooper

Bendinelli

Bivard

et al. 2020

JCM

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“… 13 Its main caveat remains lack of validation, but pilot studies show an excellent profile of sensitivity, specificity and predictive values compared with CTA and clinical examination. 13 , 15 , 16 Large-scale validation of CTP’s diagnostic accuracy in BD/DNC is ongoing through the prospective INDex-CTP study (clinicaltrials.gov: NCT03098511).…”

Section: In the Presence Of Flow Is There Brain Perfusion? (Is Water Reaching The Flower?)mentioning

confidence: 99%

“… 13 Sa principale faiblesse à ce jour demeure son manque de validation, mais les études pilotes montrent un excellent profil de sensibilité, de spécificité et de valeurs prédictives par rapport à l’angiographie par tomodensitométrie et à l’examen clinique. 13 , 15 , 16 La validation à grande échelle de l’exactitude diagnostique de la tomodensitométrie de perfusion pour la MC/DDN est en cours dans le cadre de l’étude prospective INDex-CTP (clinicaltrials.gov : NCT03098511).…”

Section: En Présence De Circulation Y A-t-il Perfusion Cérébrale ? (L’eau Atteint-elle La Fleur?)unclassified

Flow is not perfusion, and perfusion is not function: ancillary testing for the diagnosis of brain death

Plourde

Briard

Shemie

et al. 2021

Can J Anesth/J Can Anesth

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“…In a small pilot study, our group has shown that CTP could show mortality in 25% of patients at the time of their hospital admission. 32 We hypothesize that in severe TBI patients, the CTP scan done at the time of hospital admission, can diagnosis brain death reliably as opposed to the current clinical examination which is routine practice.…”

Section: Imaging For Confirmation Of Brain Deathmentioning

confidence: 99%

Early diagnosis of mortality using admission CT perfusion in severe traumatic brain injury patients (ACT-TBI): protocol for a prospective cohort study

et al. 2021

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IntroductionSevere traumatic brain injury (TBI) is a catastrophic neurological condition with significant economic burden. Early in-hospital mortality (<48 hours) with severe TBI is estimated at 50%. Several clinical examinations exist to determine brain death; however, most are difficult to elicit in the acute setting in patients with severe TBI. Having a definitive assessment tool would help predict early in-hospital mortality in this population. CT perfusion (CTP) has shown promise diagnosing early in-hospital mortality in patients with severe TBI and other populations. The purpose of this study is to validate admission CTP features of brain death relative to the clinical examination outcome for characterizing early in-hospital mortality in patients with severe TBI.Methods and analysisThe Early Diagnosis of Mortality using Admission CT Perfusion in Severe Traumatic Brain Injury Patients study, is a prospective cohort study in patients with severe TBI funded by a grant from the Canadian Institute of Health Research. Adults aged 18 or older, with evidence of a severe TBI (Glasgow Coma Scale score ≤8 before initial resuscitation) and, on mechanical ventilation at the time of imaging are eligible. Patients will undergo CTP at the time of first imaging on their hospital admission. Admission CTP compares with the reference standard of an accepted bedside clinical assessment for brainstem function. Deferred consent will be used. The primary outcome is a binary outcome of mortality (dead) or survival (not dead) in the first 48 hours of admission. The planned sample size for achieving a sensitivity of 75% and a specificity of 95% with a CI of ±5% is 200 patients.Ethics and disseminationThis study has been approved by the University of Manitoba Health Research Ethics Board. The findings from our study will be disseminated through peer-reviewed journals and presentations at local rounds, national and international conferences. The public will be informed through forums at the end of the study.Trial registration numberNCT04318665

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Admission Perfusion CT for Classifying Early In-Hospital Mortality of Patients With Severe Traumatic Brain Injury: A Pilot Study

Cited by 13 publications

References 20 publications

Abnormalities on Perfusion CT and Intervention for Intracranial Hypertension in Severe Traumatic Brain Injury

Abnormalities on Perfusion CT and Intervention for Intracranial Hypertension in Severe Traumatic Brain Injury

Flow is not perfusion, and perfusion is not function: ancillary testing for the diagnosis of brain death

Early diagnosis of mortality using admission CT perfusion in severe traumatic brain injury patients (ACT-TBI): protocol for a prospective cohort study

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