Article (Scientific journals)
Pathological Computed Tomography Features Associated With Adverse Outcomes After Mild Traumatic Brain Injury: A TRACK-TBI Study With External Validation in CENTER-TBI.
Yuh, Esther L; Jain, Sonia; Sun, Xiaoying et al.
2021In JAMA Neurology, 78 (9), p. 1137-1148
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Keywords :
Adult; Aged; Brain Concussion/complications/diagnostic imaging/pathology; Cohort Studies; Female; Humans; Intracranial Hemorrhages/diagnostic imaging/etiology; Male; Middle Aged; Prognosis; Recovery of Function; Tomography, X-Ray Computed
Abstract :
[en] IMPORTANCE: A head computed tomography (CT) with positive results for acute intracranial hemorrhage is the gold-standard diagnostic biomarker for acute traumatic brain injury (TBI). In moderate to severe TBI (Glasgow Coma Scale [GCS] scores 3-12), some CT features have been shown to be associated with outcomes. In mild TBI (mTBI; GCS scores 13-15), distribution and co-occurrence of pathological CT features and their prognostic importance are not well understood. OBJECTIVE: To identify pathological CT features associated with adverse outcomes after mTBI. DESIGN, SETTING, AND PARTICIPANTS: The longitudinal, observational Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) study enrolled patients with TBI, including those 17 years and older with GCS scores of 13 to 15 who presented to emergency departments at 18 US level 1 trauma centers between February 26, 2014, and August 8, 2018, and underwent head CT imaging within 24 hours of TBI. Evaluations of CT imaging used TBI Common Data Elements. Glasgow Outcome Scale-Extended (GOSE) scores were assessed at 2 weeks and 3, 6, and 12 months postinjury. External validation of results was performed via the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study. Data analyses were completed from February 2020 to February 2021. EXPOSURES: Acute nonpenetrating head trauma. MAIN OUTCOMES AND MEASURES: Frequency, co-occurrence, and clustering of CT features; incomplete recovery (GOSE scores <8 vs 8); and an unfavorable outcome (GOSE scores <5 vs ≥5) at 2 weeks and 3, 6, and 12 months. RESULTS: In 1935 patients with mTBI (mean [SD] age, 41.5 [17.6] years; 1286 men [66.5%]) in the TRACK-TBI cohort and 2594 patients with mTBI (mean [SD] age, 51.8 [20.3] years; 1658 men [63.9%]) in an external validation cohort, hierarchical cluster analysis identified 3 major clusters of CT features: contusion, subarachnoid hemorrhage, and/or subdural hematoma; intraventricular and/or petechial hemorrhage; and epidural hematoma. Contusion, subarachnoid hemorrhage, and/or subdural hematoma features were associated with incomplete recovery (odds ratios [ORs] for GOSE scores <8 at 1 year: TRACK-TBI, 1.80 [95% CI, 1.39-2.33]; CENTER-TBI, 2.73 [95% CI, 2.18-3.41]) and greater degrees of unfavorable outcomes (ORs for GOSE scores <5 at 1 year: TRACK-TBI, 3.23 [95% CI, 1.59-6.58]; CENTER-TBI, 1.68 [95% CI, 1.13-2.49]) out to 12 months after injury, but epidural hematoma was not. Intraventricular and/or petechial hemorrhage was associated with greater degrees of unfavorable outcomes up to 12 months after injury (eg, OR for GOSE scores <5 at 1 year in TRACK-TBI: 3.47 [95% CI, 1.66-7.26]). Some CT features were more strongly associated with outcomes than previously validated variables (eg, ORs for GOSE scores <5 at 1 year in TRACK-TBI: neuropsychiatric history, 1.43 [95% CI .98-2.10] vs contusion, subarachnoid hemorrhage, and/or subdural hematoma, 3.23 [95% CI 1.59-6.58]). Findings were externally validated in 2594 patients with mTBI enrolled in the CENTER-TBI study. CONCLUSIONS AND RELEVANCE: In this study, pathological CT features carried different prognostic implications after mTBI to 1 year postinjury. Some patterns of injury were associated with worse outcomes than others. These results support that patients with mTBI and these CT features need TBI-specific education and systematic follow-up.
Disciplines :
Human health sciences: Multidisciplinary, general & others
Author, co-author :
Yuh, Esther L;  Brain and Spinal Injury Center, San Francisco, California. ; Department of Radiology and Biomedical Imaging, University of California, San
Jain, Sonia;  Biostatistics Research Center, Herbert Wertheim School of Public Health and Human
Sun, Xiaoying;  Biostatistics Research Center, Herbert Wertheim School of Public Health and Human
Pisica, Dana;  Department of Neurosurgery, Erasmus Medical Center, Rotterdam, the Netherlands. ; Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands.
Harris, Mark H;  Brain and Spinal Injury Center, San Francisco, California. ; Department of Neurological Surgery, University of California, San Francisco, San
Taylor, Sabrina R;  Brain and Spinal Injury Center, San Francisco, California. ; Department of Neurological Surgery, University of California, San Francisco, San
Markowitz, Amy J;  Brain and Spinal Injury Center, San Francisco, California. ; Department of Neurological Surgery, University of California, San Francisco, San
Mukherjee, Pratik;  Brain and Spinal Injury Center, San Francisco, California. ; Department of Radiology and Biomedical Imaging, University of California, San
Verheyden, Jan;  Research and Development, Icometrix, Leuven, Belgium.
Giacino, Joseph T;  Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation  ; Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston,
Levin, Harvey S;  Department of Physical Medicine and Rehabilitation, Baylor College of Medicine,
McCrea, Michael;  Department of Neurosurgery, Medical College of Wisconsin, Milwaukee.
Stein, Murray B;  Department of Psychiatry, University of California San Diego, La Jolla. ; Veterans Affairs San Diego Healthcare System, San Diego, California.
Temkin, Nancy R;  Department of Neurological Surgery, University of Washington, Seattle.
Diaz-Arrastia, Ramon;  Department of Neurology, University of Pennsylvania, Philadelphia.
Robertson, Claudia S;  Department of Neurosurgery, Baylor College of Medicine, Houston, Texas.
Lingsma, Hester F;  Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands.
Okonkwo, David O;  Department of Neurological Surgery, University of Pittsburgh, Pittsburgh,
Maas, Andrew I R;  Department of Neurosurgery, Antwerp University Hospital and University of Antwerp,
Manley, Geoffrey T;  Brain and Spinal Injury Center, San Francisco, California. ; Department of Neurological Surgery, University of California, San Francisco, San
TRACK-TBI Investigators for the CENTER-TBI, Investigators
Adeoye, Opeolu;  University of Cincinnati, Cincinnati, Ohio.
Badjatia, Neeraj;  University of Maryland, College Park.
Boase, Kim;  University of Washington, Seattle.
Bodien, Yelena;  Massachusetts General Hospital, Boston.
Corrigan, John D;  Ohio State University, Dublin.
Crawford, Karen;  University of Southern California, Los Angeles.
Dikmen, Sureyya;  University of Washington, Seattle.
Duhaime, Ann-Christine;  Massachusetts General Hospital for Children, Boston.
Ellenbogen, Richard;  University of Washington, Seattle.
Feeser, V Ramana;  Virginia Commonwealth University, Richmond.
Ferguson, Adam R;  University of California, San Francisco, San Francisco.
Foreman, Brandon;  University of Cincinnati, Cincinnati, Ohio.
Gardner, Raquel;  University of California, San Francisco, San Francisco.
Gaudette, Etienne;  University of Southern California, Los Angeles.
Gonzalez, Luis;  TIRR Memorial Hermann, Houston, Texas.
Gopinath, Shankar;  Baylor College of Medicine, Houston, Texas.
Gullapalli, Rao;  University of Maryland, College Park.
Hemphill, J Claude;  University of California, San Francisco, San Francisco.
Hotz, Gillian;  University of Miami, Miami, Florida.
Keene, C Dirk;  University of Washington, Seattle.
Kramer, Joel;  University of California, San Francisco, San Francisco.
Kreitzer, Natalie;  University of Cincinnati, Cincinnati, Ohio.
Lindsell, Chris;  Vanderbilt University, Nashville, Tennessee.
Machamer, Joan;  University of Washington, Seattle.
Madden, Christopher;  UT Southwestern Medical Center, Dallas, Texas.
Martin, Alastair;  University of California, San Francisco, San Francisco.
McAllister, Thomas;  Indiana University, Bloomington.
Merchant, Randall;  Virginia Commonwealth University, Richmond.
Nelson, Lindsay;  Medical College of Wisconsin, Milwaukee.
Ngwenya, Laura B;  University of Cincinnati, Cincinnati, Ohio.
Noel, Florence;  Baylor College of Medicine, Houston, Texas.
Nolan, Amber;  University of California, San Francisco, San Francisco.
Palacios, Eva;  University of California, San Francisco, San Francisco.
Perl, Daniel;  Uniformed Services University, Bethesda, Maryland.
Rabinowitz, Miri;  University of Pittsburgh, Pittsburgh, Pennsylvania.
Rosand, Jonathan;  Massachusetts General Hospital, Boston.
Sander, Angelle;  Baylor College of Medicine, Houston, Texas.
Satris, Gabriella;  University of California, San Francisco, San Francisco.
Schnyer, David;  University of Texas at Austin, Austin.
Seabury, Seth;  University of Southern California, Los Angeles.
Toga, Arthur;  University of Southern California, Los Angeles.
Valadka, Alex;  Virginia Commonwealth University, Richmond.
Vassar, Mary;  University of California, San Francisco, San Francisco.
Zafonte, Ross;  Harvard Medical School, Boston, Massachusetts.
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Levi, Leon
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Mattern, Julia
Bellander, Bo-Michael
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Melegh, Béla
Menon, David
Menovsky, Tomas
Mikolic, Ana
Misset, Benoît ;  Centre Hospitalier Universitaire de Liège - CHU > > Service des soins intensifs
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Murray, Lynnette
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Newcombe, Virginia
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Parizel, Paul M
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Brooker, Joanne
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van Dijck, Jeroen T J M
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van Heugten, Caroline
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van Wijk, Roel P J
van Wijk, Alessia Vargiolu
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Vulekovic, Petar
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Dawes, Helen
De Keyser, Véronique ;  Université de Liège - ULiège > Département de Psychologie
Degos, Vincent
Della Corte, Francesco
den Boogert, Hugo
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GHUYSEN, Alexandre ;  Centre Hospitalier Universitaire de Liège - CHU > > Service des urgences
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More authors (230 more) Less
Language :
English
Title :
Pathological Computed Tomography Features Associated With Adverse Outcomes After Mild Traumatic Brain Injury: A TRACK-TBI Study With External Validation in CENTER-TBI.
Publication date :
01 September 2021
Journal title :
JAMA Neurology
ISSN :
2168-6149
eISSN :
2168-6157
Publisher :
American Medical Association, Us il
Volume :
78
Issue :
9
Pages :
1137-1148
Peer reviewed :
Peer Reviewed verified by ORBi
Available on ORBi :
since 27 March 2022

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