First CT findings and improvement in GOS and GOSE scores 6 and 12 months after severe traumatic brain injury

Corral, Luisa; Herrero, J.I.; Monfort, J. L.; Ventura, Josep L.; Javierre, Casimiro; Juncadella, Montserrat; García-Huete, Lucía; Bartolomé, Carlos; Gabarrós, Andreu

doi:10.1080/02699050902788477

Cited by 19 publications

(8 citation statements)

References 43 publications

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“…The characteristics of the sample are shown in Table 1[9,16]. ICP was monitored in 73% of the patients ( n = 164), 51% ( n = 83) of whom developed intracranial hypertension and 56% low cerebral perfusion pressure at some point in the evolution of their condition.…”

Section: Resultsmentioning

confidence: 99%

Impact of non-neurological complications in severe traumatic brain injury outcome

et al. 2012

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IntroductionNon-neurological complications in patients with severe traumatic brain injury (TBI) are frequent, worsening the prognosis, but the pathophysiology of systemic complications after TBI is unclear. The purpose of this study was to analyze non-neurological complications in patients with severe TBI admitted to the ICU, the impact of these complications on mortality, and their possible correlation with TBI severity.MethodsAn observational retrospective cohort study was conducted in one multidisciplinary ICU of a university hospital (35 beds); 224 consecutive adult patients with severe TBI (initial Glasgow Coma Scale (GCS) < 9) admitted to the ICU were included. Neurological and non-neurological variables were recorded.ResultsSepsis occurred in 75% of patients, respiratory infections in 68%, hypotension in 44%, severe respiratory failure (arterial oxygen pressure/oxygen inspired fraction ratio (PaO2/FiO2) < 200) in 41% and acute kidney injury (AKI) in 8%. The multivariate analysis showed that Glasgow Outcome Score (GOS) at one year was independently associated with age, initial GCS 3 to 5, worst Traumatic Coma Data Bank (TCDB) first computed tomography (CT) scan and the presence of intracranial hypertension but not AKI. Hospital mortality was independently associated with initial GSC 3 to 5, worst TCDB first CT scan, the presence of intracranial hypertension and AKI. The presence of AKI regardless of GCS multiplied risk of death 6.17 times (95% confidence interval (CI): 1.37 to 27.78) (P < 0.02), while ICU hypotension increased the risk of death in patients with initial scores of 3 to5 on the GCS 4.28 times (95% CI: 1.22 to15.07) (P < 0.05).ConclusionsLow initial GCS, worst first CT scan, intracranial hypertension and AKI determined hospital mortality in severe TBI patients. Besides the direct effect of low GCS on mortality, this neurological condition also is associated with ICU hypotension which increases hospital mortality among patients with severe TBI. These findings add to previous studies that showed that non-neurological complications increase the length of stay and morbidity in the ICU but do not increase mortality, with the exception of AKI and hypotension in low GCS (3 to 5).

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Section: Resultsmentioning

confidence: 99%

Impact of non-neurological complications in severe traumatic brain injury outcome

et al. 2012

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“…Individual CT components that predict mortality or functional outcome include degree of midline shift (4–7), intraventricular hemorrhage (IVH) (4, 8), subarachnoid hemorrhage (SAH) (6, 7, 9, 10) and presence of cerebral edema. (4–7, 11, 12) Several of these studies included children in the evaluation of CT characteristics(4, 7, 8, 11, 12), although few focused exclusively on children.…”

Section: Introductionmentioning

confidence: 99%

Use of Rotterdam CT Scores for Mortality Risk Stratification in Children With Traumatic Brain Injury*

Liesemer

Riva-Cambrin

Bennett

et al. 2014

Pediatric Critical Care Medicine

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Objective The Rotterdam computed tomography (CT) score refined features of the Marshall score and was designed to categorize traumatic brain injury (TBI) type and severity in adults. The objective of this study was to determine whether the Rotterdam CT score can be used for mortality risk stratification after pediatric TBI. Design In children with moderate to severe TBI, a comparison of observed versus predicted mortality calculated using published model probabilities of adult mortality. Development and validation of a new pediatric mortality model using randomly selected prediction and validation samples from our cohort. Setting A single level 1 pediatric trauma center. Subjects 632 children with moderate or severe TBI Interventions None. Measurements and Main Results Sixteen percent (101/632) of the patients died prior to hospital discharge. The predicted mortality based on Rotterdam score for adults with moderate or severe TBI discriminated pediatric observed mortality well (AUC = 0.85, 95% confidence interval [CI] 0.80 – 0.89) but had poor calibration, overestimating or underestimating mortality for children in several Rotterdam categories. A predictive model based on children with moderate or severe TBI from the single center discriminated mortality well (AUC 0.80, 95% CI 0.68 – 0.91) and showed good calibration and overall fit. Conclusions Children with TBI have better survival than adults in Rotterdam CT score categories representing less severe injuries, but worse survival than adults in higher score categories. A novel, validated pediatric mortality model based on the Rotterdam score is accurate in children with moderate or severe TBI and can be used for risk stratification.

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“…Standard of care imaging performed on admission and during the hospital stay of a severe TBI patient is the plain head CT. 12 Plain CT accurately and promptly diagnoses structural abnormalities but does not provide any functional information including information on brain death. [12][13][14][15][16][17] CTA is a readily available, practical, and omnipresent imaging test. However, the CTA protocol for confirmation of brain death varies considerably among different centres, which makes it difficult for it to be accepted as the gold-standard test.…”

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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First CT findings and improvement in GOS and GOSE scores 6 and 12 months after severe traumatic brain injury

Abstract: TCDB CT scan classification and subarachnoid haemorrhage were associated with GOS/GOSE improvement from 6-12 months, but individual CT abnormalities were not associated.

Cited by 19 publications

References 43 publications

Impact of non-neurological complications in severe traumatic brain injury outcome

Impact of non-neurological complications in severe traumatic brain injury outcome

Use of Rotterdam CT Scores for Mortality Risk Stratification in Children With Traumatic Brain Injury*

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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