Glasgow Coma Scale; Article; Glasgow outcome scale; Brain Injuries, Traumatic; Adult; Attention; Female; Fixation, Ocular; Humans; Intensive Care Units; Male; Predictive Value of Tests; Recovery of Function
Abstract :
[en] Objective: Posttraumatic amnesia is superior to the initial Glasgow Coma Scale score for predicting traumatic brain injury recovery, but it takes days/weeks to assess. Here, we examined whether return of visual fixation - a potential marker of higher cognitive function - within 24 hours of ICU admission could be used as an early predictor of traumatic brain injury recovery. Design: Two-phase cohort study. Setting: Level-I trauma ICU. Patients: Moderate-to-severe traumatic brain injury discharged alive between 2010 and 2013. Interventions: None. Measurements and Main Results: Return of visual fixation was assessed through standard behavioral assessments in 181 traumatic brain injury patients who had lost the ability to fixate at ICU admission (phase 1) and compared with posttraumatic amnesia duration and the initial Glasgow Coma Scale score to predict performance on the Glasgow Outcome Scale-Extended 10-40 months after injury (n = 144; phase 2a). A subgroup also completed a visual attention task (n = 35; phase 2b) and a brain MRI after traumatic brain injury (n = 23; phase 2c). With an area under the curve equal to 0.85, presence/absence of visual fixation at 24 hours of ICU admission was found as performant as posttraumatic amnesia (area under the curve, 0.81; difference between area under the curve, 0.04; p = 0.28) for predicting patients' Glasgow Outcome Scale-Extended score. Conversely, the initial Glasgow Coma Scale score was not (area under the curve, 0.63). Even when controlling for age/medication/CT scan findings, fixation remained a significant predictor of Glasgow Outcome Scale-Extended scores (β, -0.29; p < 0.05). Poorer attention performances and greater regional brain volume deficits were also observed in patients who could not fixate at 24 hours of ICU admission versus those who could. Conclusions: Visual fixation within 24 hours of ICU admission could be as performant as posttraumatic amnesia for predicting traumatic brain injury recovery, introducing a new variable of interest in traumatic brain injury outcome research.
Disciplines :
Neurology
Author, co-author :
Arbour, C.; Hôpital du Sacré-Cœur de Montréal, Montreal, QC, Canada, Department of Psychology, Université de Montréal, Montreal, QC, Canada
Baril, A.-A.; Hôpital du Sacré-Cœur de Montréal, Montreal, QC, Canada, Université de Montréal, Faculty of Medicine, Montreal, QC, Canada
Westwick, H. J.; Hôpital du Sacré-Cœur de Montréal, Montreal, QC, Canada, Université de Montréal, Faculty of Medicine, Montreal, QC, Canada
Potvin, M.-J.; Hôpital du Sacré-Cœur de Montréal, Montreal, QC, Canada, Department of Psychology, Université du Québec À Montréal, Montreal, QC, Canada
Gilbert, D.; Hôpital du Sacré-Cœur de Montréal, Montreal, QC, Canada, Université de Montréal, Faculty of Medicine, Montreal, QC, Canada
Giguère, J.-F.; Hôpital du Sacré-Cœur de Montréal, Montreal, QC, Canada
Lavigne, G. J.; Hôpital du Sacré-Cœur de Montréal, Montreal, QC, Canada, Université de Montréal, Faculty of Dental Medicine, Montreal, QC, Canada
Desautels, A.; Hôpital du Sacré-Cœur de Montréal, Montreal, QC, Canada, Université de Montréal, Faculty of Medicine, Montreal, QC, Canada
Bernard, F.; Hôpital du Sacré-Cœur de Montréal, Montreal, QC, Canada, Université de Montréal, Faculty of Medicine, Montreal, QC, Canada
Laureys, Steven ; Université de Liège - ULiège > GIGA Consciousness: Coma Science Group
Gosselin, N.; Hôpital du Sacré-Cœur de Montréal, Montreal, QC, Canada, Department of Psychology, Université de Montréal, Montreal, QC, Canada
Language :
English
Title :
Visual Fixation in the ICU: A Strong Predictor of Long-Term Recovery after Moderate-to-Severe Traumatic Brain Injury∗
Zafonte RD, Mann NR, Millis SR, et al: Posttraumatic amnesia: Its relation to functional outcome. Arch Phys Med Rehabil 1997; 78:1103-1106
Stocchetti N, Pagan F, Calappi E, et al: Inaccurate early assessment of neurological severity in head injury. J Neurotrauma 2004; 21:1131-1140
Levin HS, O'Donnell VM, Grossman RG: The Galveston Orientation and Amnesia Test. A practical scale to assess cognition after head injury. J Nerv Ment Dis 1979; 167:675-684
Steyerberg EW, Mushkudiani N, Perel P, et al: Predicting outcome after traumatic brain injury: Development and international validation of prognostic scores based on admission characteristics. PLoS Med 2008; 5:1251-1265
Jacobs B, Beems T, van der Vliet TM, et al: Outcome prediction in moderate and severe traumatic brain injury: A focus on computed tomography variables. Neurocrit Care 2013; 19:79-89
Perel P, Arango M, Clayton T, et al; MRC CRASH Trial Collaborators: Predicting outcome after traumatic brain injury: Practical prognostic models based on large cohort of international patients. BMJ 2008; 336: 425-435
Steyerberg EW, Mushkudiani N, Perel P, et al: Predicting outcome after traumatic brain injury: Development and international validation of prognostic scores based on admission characteristics. PLoS Med 2008; 5:e165
Hukkelhoven CW, Steyerberg EW, Farace E, et al: Regional differences in patient characteristics, case management, and outcomes in traumatic brain injury: Experience from the tirilazad trials. J Neurosurg 2002; 97:549-557
Brown AW, Malec JF, McClelland RL, et al: Clinical elements that predict outcome after traumatic brain injury: A prospective multicenter recursive partitioning (decision-tree) analysis. J Neurotrauma 2005; 22:1040-1051
Menon D, Harrison D: Prognostic modelling in traumatic brain injury. BMJ 2008; 336:397-398
Giacino JT, Kalmar K, Whyte J: The JFK Coma Recovery Scale-Revised: Measurement characteristics and diagnostic utility. Arch Phys Med Rehabil 2004; 85:2020-2029
Dolce G, Lucca LF, Candelieri A, et al: Visual pursuit in the severe disorder of consciousness. J Neurotrauma 2011; 28:1149-1154
Ventura RE, Balcer LJ, Galetta SL: The neuro-ophthalmology of head trauma. Lancet Neurol 2014; 13:1006-1016
Heitger MH, Anderson TJ, Jones RD, et al: Eye movement and visuomotor arm movement deficits following mild closed head injury. Brain 2004; 127:575-590
Heitger MH, Jones RD, Macleod AD, et al: Impaired eye movements in post-concussion syndrome indicate suboptimal brain function beyond the influence of depression, malingering or intellectual ability. Brain 2009; 132:2850-2870
Ramat S, Leigh RJ, Zee DS, et al: What clinical disorders tell us about the neural control of saccadic eye movements. Brain 2007; 130:10-35
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders. Fifth Edition. Washington, DC, 2013
Teasdale G, Jennett B: Assessment of coma and impaired consciousness. A practical scale. Lancet 1974; 2:81-84
Heather NL, Derraik JG, Beca J, et al: Glasgow Coma Scale and outcomes after structural traumatic head injury in early childhood. PLoS One 2013; 8:e82245
Mena JH, Sanchez AI, Rubiano AM, et al: Effect of the modified Glasgow Coma Scale score criteria for mild traumatic brain injury on mortality prediction: Comparing classic and modified Glasgow Coma Scale score model scores of 13. J Trauma 2011; 71:1185-1192; discussion 1193
Ellenberg JH, Levin HS, Saydjari C: Posttraumatic Amnesia as a predictor of outcome after severe closed head injury. Prospective assessment. Arch Neurol 1996; 53:782-791
Stuss DT, Binns MA, Carruth FG, et al: The acute period of recovery from traumatic brain injury: Posttraumatic amnesia or posttraumatic confusional state? J Neurosurg 1999; 90:635-643
Marshall LF, Eisenberg H, Jane JA, et al: A new classification of head injury based on computed tomography. J Neurosurg 1991; 75:S14-S20
Maas AI, Hukkelhoven CW, Marshall LF, et al: Prediction of outcome in traumatic brain injury with computed tomographic characteristics: A comparison between the computed tomographic classification and combinations of computed tomographic predictors. Neurosurgery 2005; 57:1173-1182; discussion 1173
Firsching R, Woischneck D, Klein S, et al: Classification of severe head injury based on magnetic resonance imaging. Acta Neurochir (Wien) 2001; 143:263-271
Yawn BP, Wollan P: Interrater reliability: Completing the methods description in medical records review studies. Am J Epidemiol 2005; 161:974-977
Streiner DL, Norman GR: Health Measurement Scales: A Practical Guide to Their Development and Use. Fourth Edition. Oxford, Oxford University Press, 2008
Wilson JT, Pettigrew LE, Teasdale GM: Structured interviews for the Glasgow Outcome Scale and the extended Glasgow Outcome Scale: Guidelines for their use. J Neurotrauma 1998; 15:573-585
Takahashi M, Iwamoto K, Fukatsu H, et al: White matter microstructure of the cingulum and cerebellar peduncle is related to sustained attention and working memory: A diffusion tensor imaging study. Neurosci Lett 2010; 477:72-76
Nowrangi MA, Lyketsos C, Rao V, et al: Systematic review of neuroimaging correlates of executive functioning: Converging evidence from different clinical populations. J Neuropsychiatry Clin Neurosci 2014; 26:114-125
Horn AK, Büttner-Ennever JA, Wahle P, et al: Neurotransmitter profile of saccadic omnipause neurons in nucleus raphe interpositus. J Neurosci 1994; 14:2032-2046
Leigh JR, Zee DS: The Neurology of Eye Movements. Fifth Edition. Oxford, Oxford University Press, 2015
Wilde EA, Bigler ED, Hunter JV, et al: Hippocampus, amygdala, and basal ganglia morphometrics in children after moderate-to-severe traumatic brain injury. Dev Med Child Neurol 2007; 49:294-299
Murray GD, Butcher I, McHugh GS, et al: Multivariable prognostic analysis in traumatic brain injury: Results from the IMPACT study. J Neurotrauma 2007; 24:329-337
Kehoe A, Rennie S, Smith JE: Glasgow Coma Scale is unreliable for the prediction of severe head injury in elderly trauma patients. Emerg Med J 2015; 32:613-615
Forslund MV, Roe C, Sigurdardottir S, et al: Predicting health-related quality of life 2 years after moderate-to-severe traumatic brain injury. Acta Neurol Scand 2013; 128:220-227
Bruno MA, Ledoux D, Lambermont B, et al: Comparison of the Full Outline of UnResponsiveness and Glasgow Liege Scale/Glasgow Coma Scale in an intensive care unit population. Neurocrit Care 2011; 15:447-453
Sharp DJ, Scott G, Leech R: Network dysfunction after traumatic brain injury. Nat Rev Neurol 2014; 10:156-166
Granziera C, Schmahmann JD, Hadjikhani N, et al: Diffusion spectrum imaging shows the structural basis of functional cerebellar circuits in the human cerebellum in vivo. PLoS One 2009; 4:e5101
Rogers TD, McKimm E, Dickson PE, et al: Is autism a disease of the cerebellum? An integration of clinical and pre-clinical research. Front Syst Neurosci 2013; 7:15
Bruno MA, Vanhaudenhuyse A, Schnakers C, et al: Visual fixation in the vegetative state: An observational case series PET study. BMC Neurol 2010; 10:35
Di H, Nie Y, Hu X, et al: Assessment of visual fixation in vegetative and minimally conscious states. BMC Neurol 2014; 14:147
Lingsma HF, Roozenbeek B, Li B, et al: Large between-center differences in outcome after moderate and severe traumatic brain injury in the international mission on prognosis and clinical trial design in traumatic brain injury (IMPACT) study. Neurosurgery 2011; 68:601-607
