Prediction of Outcome after Traumatic Brain Injury Using Clinical and Neuroimaging Variables

Abstract

Background and PurposeThe functional outcome of traumatic brain injury (TBI) varies widely. The aim of this study was to identify the factors predicting outcome following TBI.MethodsWe prospectively enrolled acute TBI patients, and assessed them clinically and radiologically using brain magnetic resonance imaging (MRI). Functional outcome was measured using the Glasgow Outcome Scale (GOS) at 3 months after TBI. A GOS score of ≤4 was regarded as an unfavorable outcome. We performed multivariate analysis to investigate the association between clinicoradiological variables and outcome.ResultsForty-two patients completed the clinical evaluation in the acute phase and outcome measurement at 3 months. Motorcycle accident was associated with unfavorable outcome [odds ratio (OR)=38.3, p=0.022]. If the patients were the victims of the accident, they were more likely to have an unfavorable outcome (OR=21.3, p=0.037). All seven patients with a low Glasgow Coma Scale (GCS) score (i.e., ≤8) at 24 or 48 h after TBI were also found to have an unfavorable outcome. The presence of diffuse axonal injury (DAI) was a significant predicting factor of an unfavorable outcome (OR=8.48, p=0.042).ConclusionsMotorcycle accident, being an accident victim, and a lower GCS score at 24 hours or more after the accident were found to be unfavorable prognostic variables. DAI was the only radiologic variable predicting an unfavorable outcome. Thus, it is important to identify DAI by applying MRI in the acute phase.

Prognostic Value of Early Magnetic Resonance Imaging in Dogs after Traumatic Brain Injury: 50 Cases

“…22 Recent studies have focused on MRI findings as predictors of clinical out-come because of its high sensitivity for the detection of nonhemorrhagic contusions, brainstem lesions, and diffuse axonal injuries. 17,18,[23][24][25][26] MRI analysis and grading reported in this study appear to have clinical relevance because of their significant correlation with outcome. This study used a grading system modified from human medicine, where the severity and location of the lesions were taken into account.…”

Diffuse axonal injury after traumatic brain injury is a prognostic factor for functional outcome: a systematic review and meta-analysis

“…In this first category, all patients with DAI were included to determine the prognosis for this entire group of patients. Articles describing outcome in patients with DAI in the acute and subacute phase after injury were included, which resulted in 13 articles describing a total of 549 patients with a mean age of 33.5 years (4,9,(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22). DAI was present in 449 patients, and an unfavourable outcome was found in 38% (n = 169, 95% CI 0.33-0.42).…”

Contribution of Psychological Trauma to Outcomes after Traumatic Brain Injury: Assaults versus Sporting Injuries

“…[2][3][4] With mild TBIs (mTBIs), people typically experience a range of short-term postconcussive symptoms (PCSs) that usually resolve in the first few months after an injury; however, a substantial minority report experiencing long-term problems. [5][6][7] Moderate-to-severe injuries, on the other hand, are generally associated with poorer outcomes, [8][9][10][11][12] although outcomes can vary appreciably between injuries that are ostensibly similar in severity. 13,14 Consequently, it remains difficult to accurately predict outcomes at an individual, rather than group, level on the basis of injury severity.…”