Cumulative incidence and predictors of neurosurgical interventions following nonsevere traumatic brain injury with mildly abnormal head imaging findings

Wu, Chris Y.; Orringer, Daniel A.; Lau, Darryl; Fletcher, Jeffrey J.

doi:10.1097/ta.0b013e318265d24e

Cited by 17 publications

(10 citation statements)

References 12 publications

(8 reference statements)

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“…Skull fractures were observed in this model of closed skull TBl, which parallels findings that skull fractures occur in 30% of mild to moderate patients with TBI (103). The majority of skull fractures were either branched or linear but some depressed skull fractures were observed.…”

Section: Glil-creertsupporting

confidence: 66%

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The Regenerative Response of Endogenous Neural Stem/Progenitor Cells to Traumatic Brain Injury

Sullivan¹

2014

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Section: Glil-creertsupporting

confidence: 66%

“…However, linear skull fractures may be considered an interesting component of the impact injury given that skull fractures are found in over 30% of mild-moderate human TBI cases (103).…”

Section: Discussionmentioning

confidence: 99%

The Regenerative Response of Endogenous Neural Stem/Progenitor Cells to Traumatic Brain Injury

Sullivan¹

2014

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“…Variation could be reduced by excluding mice based on specific parameters, such as depressed skull fractures, which correspond with more severe bleeding. However, linear skull fractures may be considered an interesting component of the impact injury because skull fractures are found in more than 30% of mild-moderate human TBI cases (41). …”

Section: Discussionmentioning

confidence: 99%

Oligodendrocyte Lineage and Subventricular Zone Response to Traumatic Axonal Injury in the Corpus Callosum

Sullivan¹,

Mierzwa²,

Kijpaisalratana³

et al. 2013

J Neuropathol Exp Neurol

113

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Traumatic brain injury frequently causes traumatic axonal injury (TAI) in white matter tracts. Experimental TAI in the corpus callosum of adult mice was used to examine the effects on oligodendrocyte lineage cells and myelin in conjunction with neuroimaging. The injury targeted the corpus callosum over the subventricular zone, a source of neural stem/progenitor cells. TAI was produced in the rostral body of the corpus callosum by impact onto the skull at bregma. During the first week post-injury, magnetic resonance diffusion tensor imaging showed that axial diffusivity decreased in the corpus callosum and that corresponding regions exhibited significant axon damage accompanied by hypertrophic microglia and reactive astrocytes. Oligodendrocyte progenitor proliferation increased in the subventricular zone and corpus callosum. Oligodendrocytes in the corpus callosum shifted toward upregulation of myelin gene transcription. Plp/CreERT:R26IAP reporter mice showed normal reporter labeling of myelin sheaths 0 to 2 days post-injury but labeling was increased between 2 to 7 days post-injury. Electron microscopy revealed axon degeneration, demyelination and redundant myelin figures. These findings expand the cell types and responses to white matter injuries that inform diffusion tensor imaging evaluation and identify pivotal white matter changes following TAI that may affect axon vulnerability vs. recovery following brain injury.

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“…Although a change in GCS score is used to identify neurological deterioration, which is often an indication for a neurosurgical intervention, admission GCS score has been repeatedly shown to be a poor determinant of subsequent neurosurgical intervention; our study lends support to this conclusion. 3,27,36 This reoccurring observation should not be unexpected because the GCS was designed to reflect differences in the risk for mortality, not neurosurgical intervention. When we examined the interaction of GCS score and hemorrhage thickness in a multivariable logistic regression model, the odds of neurosurgical intervention for each millimeter increase in hemorrhage thickness was similar for each admission GCS group (p-interaction 0.19).…”

Section: Discussionmentioning

confidence: 98%

“…A question repeatedly posed in the TBI literature is whether a neurosurgical consultation, or a requirement for neurosurgical coverage, is necessary for all patients with an mTBI and ICH. 2,3,8,11,14,17,36 Unfortunately, we do not have enough of an understanding of the risk for neurosurgical intervention to create management guidelines addressing particular ICH types in patients with mTBI. 9 In order to better understand the risk, we must collect detailed information about each injury and assess the influence of each variable on the risk of neurosurgical intervention through predictive modeling.…”

mentioning

confidence: 99%

Isolated subdural hematomas in mild traumatic brain injury. Part 1: the association between radiographic characteristics and neurosurgical intervention

Orlando¹,

Levy²,

Rubin

et al. 2019

Journal of Neurosurgery

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OBJECTIVE Isolated subdural hematomas (iSDHs) are one of the most common intracranial hemorrhage (ICH) types in the population with mild traumatic brain injury (mTBI; Glasgow Coma Scale score 13-15), account for 66%-75% of all neurosurgical procedures, and have one of the highest neurosurgical intervention rates. The objective of this study was to examine how quantitative hemorrhage characteristics of iSDHs in patients with mTBI at admission are associated with subsequent neurosurgical intervention. METHODS This was a 3.5-year, retrospective observational cohort study at a Level I trauma center. All adult trauma patients with mTBI and iSDHs were included in the study. Maximum length and thickness (in mm) of acute SDHs, the presence of acute-on-chronic SDH, mass effect, and other hemorrhage-related variables were double-data entered; discrepant results were adjudicated after a maximum of 4 reviews. Patients with coagulopathy, skull fractures, no acute hemorrhage, a non-SDH ICH, or who did not undergo imaging on admission were excluded. The primary outcome was neurosurgical intervention (craniotomy, burr hole, catheter drainage of SDH, placement of intracranial pressure monitor, shunt, or ventriculostomy). Multivariate stepwise logistic regression was used to identify significant covariates and to assess interactions. RESULTS A total of 176 patients were included in our study: 28 patients did and 148 patients did not receive a neurosurgical intervention. Increasing head Abbreviated Injury Scale score was significantly associated with neurosurgical interventions. There was a strong correlation between the first 3 reviews on maximum hemorrhage length (R = 0.82) and maximum hemorrhage thickness (R = 0.80). The neurosurgical intervention group had a mean maximum SDH length and thickness that were 61 mm longer and 13 mm thicker than those of the nonneurosurgical intervention group (p < 0.001 for both). After adjusting for the presence of an acute-on-chronic hemorrhage, for every 1-mm increase in the thickness of an iSDH, the odds of a neurosurgical intervention increase by 32% (95% CI 1.16-1.50). There were no interventions for any SDH with a maximum thickness ≤ 5 mm on initial presenting scan. CONCLUSIONS This is the first study to quantify the odds of a neurosurgical intervention based on hemorrhage characteristics in patients with an iSDH and mTBI. Once validated in a second population, these data can be used to better inform patients and families of the risk of future neurosurgical intervention, and to evaluate the necessity of interhospital transfers.

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Cumulative incidence and predictors of neurosurgical interventions following nonsevere traumatic brain injury with mildly abnormal head imaging findings

Abstract: Prognostic study, level III; therapeutic study, level IV.

Cited by 17 publications

References 12 publications

The Regenerative Response of Endogenous Neural Stem/Progenitor Cells to Traumatic Brain Injury

The Regenerative Response of Endogenous Neural Stem/Progenitor Cells to Traumatic Brain Injury

Oligodendrocyte Lineage and Subventricular Zone Response to Traumatic Axonal Injury in the Corpus Callosum

Isolated subdural hematomas in mild traumatic brain injury. Part 1: the association between radiographic characteristics and neurosurgical intervention

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