1. Prognostic Value of Hemorrhagic Brainstem Injury on Early Computed Tomography: A TRACK-TBI Study.
- Author
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Williams, John R, Nieblas-Bedolla, Edwin, Feroze, Abdullah, Young, Christopher, Temkin, Nancy R, Giacino, Joseph T, Okonkwo, David O, Manley, Geoffrey T, Barber, Jason, Durfy, Sharon, Markowitz, Amy J, Yuh, Esther L, Mukherjee, Pratik, Mac Donald, Christine L, and and The Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) Investigators
- Subjects
and The Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) Investigators ,Brain Stem ,Humans ,Tomography ,X-Ray Computed ,Prognosis ,Glasgow Coma Scale ,Retrospective Studies ,Prospective Studies ,Brain Injuries ,Traumatic ,Brainstem injury ,Computed tomography ,Outcomes ,Traumatic axonal injury ,Traumatic brain injury ,Biomedical Imaging ,Neurosciences ,Physical Injury - Accidents and Adverse Effects ,Traumatic Head and Spine Injury ,Brain Disorders ,Traumatic Brain Injury (TBI) ,Injuries and accidents ,Clinical Sciences ,Neurology & Neurosurgery - Abstract
BackgroundTraumatic 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.MethodsPatients 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.ResultsMann-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).ConclusionsThese 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.
- Published
- 2021