Magnetic resonance imaging improves 3-month outcome prediction in mild traumatic brain injury
Esther L. Yuh,Pratik Mukherjee,Hester F. Lingsma,John K. Yue,Adam R. Ferguson,Wayne A. Gordon,Alex B. Valadka,David M. Schnyer,David O. Okonkwo,Andrew I R Maas,Geoffrey T. Manley +10 more
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To determine the clinical relevance, if any, of traumatic intracranial findings on early head computed tomography (CT) and brain magnetic resonance imaging (MRI) to 3‐month outcome in mild traumatic brain injury (MTBI), a large number of patients were treated for at least three months after injury.Abstract:
Objective: To determine the clinical relevance, if any, of traumatic intracranial findings on early head computed tomography (CT) and brain magnetic resonance imaging (MRI) to 3-month outcome in mild traumatic brain injury (MTBI). Methods: One hundred thirty-five MTBI patients evaluated for acute head injury in emergency departments of 3 LEVEL I trauma centers were enrolled prospectively. In addition to admission head CT, early brain MRI was performed 12 6 3.9 days after injury. Univariate and multivariate logistic regression were used to assess for demographic, clinical, socioeconomic, CT, and MRI features that were predictive of Extended Glasgow Outcome Scale (GOS-E) at 3 months postinjury. Results: Twenty-seven percent of MTBI patients with normal admission head CT had abnormal early brain MRI. CT evidence of subarachnoid hemorrhage was associated with a multivariate odds ratio of 3.5 (p ¼ 0.01) for poorer 3month outcome, after adjusting for demographic, clinical, and socioeconomic factors. One or more brain contusions on MRI, and � 4 foci of hemorrhagic axonal injury on MRI, were each independently associated with poorer 3-month outcome, with multivariate odds ratios of 4.5 (p ¼ 0.01) and 3.2 (p ¼ 0.03), respectively, after adjusting for head CT findings and demographic, clinical, and socioeconomic factors. Interpretation: In this prospective multicenter observational study, the clinical relevance of abnormal findings on early brain imaging after MTBI is demonstrated. The addition of early CT and MRI markers to a prognostic model based on previously known demographic, clinical, and socioeconomic predictors resulted in a >2-fold increase in the explained variance in 3-month GOS-E. ANN NEUROL 2012;00:000–000read more
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Traumatic brain injury: integrated approaches to improve prevention, clinical care, and research
Andrew I R Maas,David K. Menon,P. David Adelson,Nada Andelic,Michael J. Bell,Antonio Belli,Peter Bragge,Alexandra Brazinova,Andras Buki,Randall M. Chesnut,Giuseppe Citerio,Mark Coburn,D. Jamie Cooper,A Tamara Crowder,Endre Czeiter,Marek Czosnyka,Ramon Diaz-Arrastia,Jens P. Dreier,Ann-Christine Duhaime,Ari Ercole,Thomas A. van Essen,Valery L. Feigin,Guoyi Gao,Joseph T. Giacino,Laura E. Gonzalez-Lara,Russell L. Gruen,Russell L. Gruen,Deepak Gupta,Jed A. Hartings,Sean Hill,Jiyao Jiang,Naomi Ketharanathan,Erwin J. O. Kompanje,Linda Lanyon,Steven Laureys,Fiona Lecky,Harvey S. Levin,Hester F. Lingsma,Marc Maegele,Marek Majdan,Geoffrey T. Manley,Jill A. Marsteller,Luciana Mascia,Charles McFadyen,Stefania Mondello,Virginia F. J. Newcombe,Aarno Palotie,Aarno Palotie,Aarno Palotie,Paul M. Parizel,Wilco C. Peul,James Piercy,Suzanne Polinder,Louis Puybasset,Todd E. Rasmussen,Rolf Rossaint,Peter Smielewski,Jeannette Söderberg,Simon J. Stanworth,Murray B. 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TL;DR: The InTBIR Participants and Investigators have provided informed consent for the study to take place in Poland.
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