Measures of Injury Severity and Prediction of Acute Traumatic Brain Injury Outcomes

Perrin, Paul B.; Mougeot, Jean Luc; Vannoy, Charles H.; Hirsch, Mark A.; Watts, John A.; Rossman, Whitney; Grafton, Lori; Guerrier, Tami D.; Pershad, Rashmi; Kingsbury, Carla A.; Bartel, Sheri; Whitney, Marybeth

doi:10.1097/htr.0000000000000026

Cited by 41 publications

(17 citation statements)

References 9 publications

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“…Often, the medical literature on traumatic brain injury is divided into the acute phase (where the focus is often mortality) and longer-term studies on outcomes after rehabilitation. There is a body of rehabilitation literature that looks at pre-injury and general injury characteristics to predict outcomes after TBI [17][18][19][20][21][22]. However, much of the time these studies do not utilize specific data or have access to actual radiographic imaging data (beyond printed reports) from the day of injury to prognosticate long-term outcomes.…”

Section: Discussionmentioning

confidence: 99%

Volumetric analysis of day of injury computed tomography is associated with rehabilitation outcomes after traumatic brain injury

Majercik

Bledsoe

Ryser

et al. 2017

Journal of Trauma and Acute Care Surgery

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Introduction Day-of-injury (DOI) brain lesion volumes in traumatic brain injury (TBI) patients are rarely used to predict long-term outcomes in the acute setting. The purpose of this study was to investigate the relationship between acute brain injury lesion volume and rehabilitation outcomes in patients with TBI at a Level One Trauma Center. Methods Patients with TBI who were admitted to our rehabilitation unit after the acute care trauma service from February 2009-July 2011 were eligible for the study. Demographic data and outcome variables including cognitive and motor FIM scores, length of stay (LOS) in the rehabilitation unit, and ability to return to home were obtained. DOI quantitative injury lesion volumes and degree of midline shift were obtained from day-of-injury (DOI) brain computed tomography (CT) scans. A multiple step-wise regression model including 13 independent variables was created. This model was used to predict post-rehabilitation outcomes, including FIM scores and ability to return to home. P<0.05 was considered significant. Results 96 patients were enrolled in the study. Mean age was 43±21 years, admission Glasgow Coma Score 8.4±4.8, Injury Severity Score 24.7±9.9, and head Abbreviated Injury Scale score 3.73±0.97. Acute hospital length of stay (LOS) was 12.3±8.9 days and rehabilitation LOS was 15.9±9.3 days. Day-of-injury TBI lesion volumes were inversely associated with cognitive FIM scores at rehabilitation admission (p=0.004) and discharge (p=0.004) and inversely associated with ability to be discharged to home after rehabilitation (p=0.006). Conclusion In a cohort of patients with moderate to severe TBI requiring a rehabilitation unit stay after the acute care hospital stay, DOI brain injury lesion volumes are associated with worse cognitive FIM scores at the time of rehabilitation admission and discharge. Smaller injury volumes were associated with eventual discharge to home. Volumetric neuroimaging in the acute injury phase may improve surgeons’ ultimate outcome predictions in TBI patients. Level of Evidence/Study Type Level V, case series, Prognostic/Epidemiological

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Section: Discussionmentioning

confidence: 99%

Volumetric analysis of day of injury computed tomography is associated with rehabilitation outcomes after traumatic brain injury

Majercik

Bledsoe

Ryser

et al. 2017

Journal of Trauma and Acute Care Surgery

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“…Recent studies, however, have argued that the GCS score by itself is inadequate to classify the severity of TBI 7,37 or to predict functionality at discharge after TBI. 32 Salottolo et al 37 reported that elderly patients have higher GCS scores than younger patients with similar TBI severity, and Chieregato et al 7 argued that CT findings should be incorporated into TBI severity definitions. Saatman et al 36 point out that the GCS score does not provide specific information about the pathophysiological mechanisms responsible for neurological deficits.…”

Section: The Sdh Evaluation Augments Gcs Score Assessmentmentioning

confidence: 99%

Subdural hematoma as a major determinant of short-term outcomes in traumatic brain injury

Lee

Segar

Morrison

et al. 2018

Journal of Neurosurgery

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OBJECTIVE Early radiographic findings in patients with traumatic brain injury (TBI) have been studied in hopes of better predicting injury severity and outcome. However, prior attempts have generally not considered the various types of intracranial hemorrhage in isolation and have typically not excluded patients with potentially confounding extracranial injuries. Therefore, the authors examined the associations of various radiographic findings with short-term outcome to assess the potential utility of these findings in future prognostic models. METHODS The authors retrospectively identified 1716 patients who had experienced TBI without major extracranial injuries, and categorized them into the following TBI subtypes: subdural hematoma (SDH), traumatic subarachnoid hemorrhage, intraparenchymal hemorrhage (which included intraventricular hemorrhage), and epidural hematoma. They specifically considered isolated forms of hemorrhage, in which only 1 subtype was present. RESULTS In general, the presence of an isolated SDH was more likely to result in worse outcomes than the presence of other isolated forms of traumatic intracranial hemorrhage. Discharge to home was less likely and perihospital mortality rates were generally higher in patients with SDH. These findings were not simply related to age and were not fully captured by the admission Glasgow Coma Scale (GCS) score. The presence of SDH had a much higher sensitivity for poor outcome than the presence of other TBI subtypes, and was more sensitive for these poor outcomes than having a low GCS score (3-8). CONCLUSIONS In these ways, SDH was the most important finding associated with poor outcome, and the authors show that consideration of SDH, specifically, can augment age and GCS score in classification and prognostic models for TBI.

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“…In addition, positive findings of studies of hormonal neuroprotection, which is thought to have been demonstrated in animal research, have been inconsistent in human research [51]. Current studies on measures of injury severity suggest that the duration of post-traumatic amnesia may be the most meaningful predictor of a patient's functional level at discharge [52].…”

Section: Ongoing Needs and Future Promisementioning

confidence: 99%

Treating Persons With Traumatic Brain Injury

Grafton

Chilakamarri

2015

North Carolina Medical Journal

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Measures of Injury Severity and Prediction of Acute Traumatic Brain Injury Outcomes

Abstract: Although clinicians often use GCS scores and TTC when assessing acute TBI severity and during treatment formulation, this study provides evidence that duration of PTA may be a more meaningful predictor of patients' functional levels at discharge.

Cited by 41 publications

References 9 publications

Volumetric analysis of day of injury computed tomography is associated with rehabilitation outcomes after traumatic brain injury

Volumetric analysis of day of injury computed tomography is associated with rehabilitation outcomes after traumatic brain injury

Subdural hematoma as a major determinant of short-term outcomes in traumatic brain injury

Treating Persons With Traumatic Brain Injury

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