Prognostic Value of Hemorrhagic Brainstem Injury on Early Computed Tomography: A TRACK-TBI Study.
Brainstem injury
Computed tomography
Outcomes
Traumatic axonal injury
Traumatic brain injury
Journal
Neurocritical care
ISSN: 1556-0961
Titre abrégé: Neurocrit Care
Pays: United States
ID NLM: 101156086
Informations de publication
Date de publication:
10 2021
10 2021
Historique:
received:
07
01
2021
accepted:
21
04
2021
pubmed:
27
7
2021
medline:
16
11
2021
entrez:
26
7
2021
Statut:
ppublish
Résumé
Traumatic brainstem injury has yet to be incorporated into widely used imaging classification systems for traumatic brain injury (TBI), and questions remain regarding prognostic implications for this TBI subgroup. To address this, retrospective data on patients from the multicenter prospective Transforming Research and Clinical Knowledge in TBI study were studied. Patients with brainstem and cerebrum injury (BSI+) were matched by age, sex, and admission Glasgow Coma Scale (GCS) score to patients with cerebrum injuries only. All patients had an interpretable head computed tomography (CT) scan from the first 48 hours after injury and a 6-month Glasgow Outcome Scale Extended (GOSE) score. CT scans were reviewed for brainstem lesions and, when present, characterized by location, size, and type (traumatic axonal injury, contusion, or Duret hemorrhage). Clinical, demographic, and outcome data were then compared between the two groups. Mann-Whitney U-tests showed no significant difference in 6-month GOSE scores in patients with BSI+ (mean 2.7) compared with patients with similar but only cerebrum injuries (mean 3.9), although there is a trend (p = 0.10). However, subclassification by brainstem lesion type, traumatic axonal injury (mean 4.0) versus Duret hemorrhage or contusion (mean 1.4), did identify a proportion of BSI+ with significantly less favorable outcome (p = 0.002). The incorporation of brainstem lesion type (traumatic axonal injury vs. contusion/Duret), along with GCS into a multivariate logistic regression model of favorable outcome (GOSE score 4-8) did show a significant contribution to the prognostication of this brainstem injury subgroup (odds ratio 0.08, 95% confidence interval 0.00-0.67, p = 0.01). These findings suggest two groups of patients with brainstem injuries may exist with divergent recovery potential after TBI. These data support the notion that newer CT imaging classification systems may augment traditional clinical measures, such as GCS in identifying those patients with TBI and brainstem injuries that stand a higher chance of favorable outcome.
Sections du résumé
BACKGROUND
Traumatic brainstem injury has yet to be incorporated into widely used imaging classification systems for traumatic brain injury (TBI), and questions remain regarding prognostic implications for this TBI subgroup. To address this, retrospective data on patients from the multicenter prospective Transforming Research and Clinical Knowledge in TBI study were studied.
METHODS
Patients with brainstem and cerebrum injury (BSI+) were matched by age, sex, and admission Glasgow Coma Scale (GCS) score to patients with cerebrum injuries only. All patients had an interpretable head computed tomography (CT) scan from the first 48 hours after injury and a 6-month Glasgow Outcome Scale Extended (GOSE) score. CT scans were reviewed for brainstem lesions and, when present, characterized by location, size, and type (traumatic axonal injury, contusion, or Duret hemorrhage). Clinical, demographic, and outcome data were then compared between the two groups.
RESULTS
Mann-Whitney U-tests showed no significant difference in 6-month GOSE scores in patients with BSI+ (mean 2.7) compared with patients with similar but only cerebrum injuries (mean 3.9), although there is a trend (p = 0.10). However, subclassification by brainstem lesion type, traumatic axonal injury (mean 4.0) versus Duret hemorrhage or contusion (mean 1.4), did identify a proportion of BSI+ with significantly less favorable outcome (p = 0.002). The incorporation of brainstem lesion type (traumatic axonal injury vs. contusion/Duret), along with GCS into a multivariate logistic regression model of favorable outcome (GOSE score 4-8) did show a significant contribution to the prognostication of this brainstem injury subgroup (odds ratio 0.08, 95% confidence interval 0.00-0.67, p = 0.01).
CONCLUSIONS
These findings suggest two groups of patients with brainstem injuries may exist with divergent recovery potential after TBI. These data support the notion that newer CT imaging classification systems may augment traditional clinical measures, such as GCS in identifying those patients with TBI and brainstem injuries that stand a higher chance of favorable outcome.
Identifiants
pubmed: 34309784
doi: 10.1007/s12028-021-01263-8
pii: 10.1007/s12028-021-01263-8
pmc: PMC8727027
mid: NIHMS1766371
doi:
Types de publication
Journal Article
Multicenter Study
Research Support, N.I.H., Extramural
Research Support, U.S. Gov't, Non-P.H.S.
Langues
eng
Sous-ensembles de citation
IM
Pagination
335-346Subventions
Organisme : NINDS NIH HHS
ID : U01 NS086090
Pays : United States
Investigateurs
Opeolu Adeoye
(O)
Neeraj Badjatia
(N)
Kim Boase
(K)
Yelena Bodien
(Y)
M Ross Bullock
(MR)
Randall Chesnut
(R)
John D Corrigan
(JD)
Karen Crawford
(K)
Ramon Diaz-Arrastia
(R)
Sureyya Dikmen
(S)
Ann-Christine Duhaime
(AC)
Richard Ellenbogen
(R)
V Ramana Feeser
(VR)
Adam R Ferguson
(AR)
Brandon Foreman
(B)
Raquel Gardner
(R)
Etienne Gaudette
(E)
Dana Goldman
(D)
Luis Gonzalez
(L)
Shankar Gopinath
(S)
Rao Gullapalli
(R)
J Claude Hemphill
(JC)
Gillian Hotz
(G)
Sonia Jain
(S)
C Dirk Keene
(CD)
Frederick K Korley
(FK)
Joel Kramer
(J)
Natalie Kreitzer
(N)
Harvey Levin
(H)
Chris Lindsell
(C)
Joan Machamer
(J)
Christopher Madden
(C)
Alastair Martin
(A)
Thomas McAllister
(T)
Michael McCrea
(M)
Randall Merchant
(R)
Lindsay Nelson
(L)
Laura B Ngwenya
(LB)
Florence Noel
(F)
Amber Nolan
(A)
Eva Palacios
(E)
Daniel Perl
(D)
Ava Puccio
(A)
Miri Rabinowitz
(M)
Claudia Robertson
(C)
Jonathan Rosand
(J)
Angelle Sander
(A)
Gabriella Satris
(G)
David Schnyer
(D)
Seth Seabury
(S)
Murray Stein
(M)
Sabrina Taylor
(S)
Arthur Toga
(A)
Alex Valadka
(A)
Mary Vassar
(M)
Paul Vespa
(P)
Kevin Wang
(K)
John K Yue
(JK)
Ross Zafonte
(R)
Commentaires et corrections
Type : CommentIn
Type : ErratumIn
Informations de copyright
© 2021. Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society.
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