Acute bilateral mass-occupying lesions in non-penetrating traumatic brain injury: a retrospective study

Hu, Yu; Sun, Hong; Yuan, Yanqing; Li, Qiang; Huang, Suli; Jiang, Shu; Liu, Kaili; Yang, Chaohua

doi:10.1186/1471-2482-15-6

Cited by 5 publications

(7 citation statements)

References 21 publications

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“…Acute subdural and epidural hematomas are among the most common causes of mortality and disability resulting from head injury 13 . In our study, subdural hematoma was the most common CT fi nding in patients with head trauma, which is in concordance with other study results, although the rates of other head injury types vary from study to study 14,15 . Špero et al found head trauma in 28.93% of cases with pathologic emergency brain CT fi ndings, including skull fractures 12 .…”

Section: Discussionsupporting

confidence: 82%

Evaluation of the Head Multislice Computed Tomography Scan in Emergency Department

Zadravec

Gregurić

Smoljan

et al. 2017

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SUMMARY -Th e aim of the study was to examine the prevalence of head injuries, acute stroke and brain tumors obtained from computed tomography (CT) scans in the emergency department (ED) during a one-year period. We also assessed the potential eff ect of seasons on the occurrence of stroke, head trauma and tumors found on CT scans, expressed in monthly intervals. Th is retrospective review included all patients that underwent emergency head CT from the hospital database. A total of 3888 head CT examinations were performed in adult patients presenting to ED and 1424 CT scans had at least one pathologic fi nding meeting diagnostic criteria for the study. Of the total number of CT scans analyzed, acute stroke was identifi ed in 552 (14.19%), head trauma in 660 (16.97%), and brain tumor in 212 (5.45%) patients. Head trauma was more commonly found in males (n=465, 70.45%) than in females (n=195, 29.54%). Acute stroke was slightly more common in males than in females. Brain tumors were more frequently found in female patients. Th ere were monthly variations in the number of head injuries and acute stroke diagnosed during the study period. Men and elderly patients were found to account for the greatest number of traumatic head injuries and therefore are at the highest risk of possible brain injury.

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Section: Discussionsupporting

confidence: 82%

Evaluation of the Head Multislice Computed Tomography Scan in Emergency Department

Zadravec

Gregurić

Smoljan

et al. 2017

acc

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“…These findings are very much in line with previous studies. [19][20][21][22][23][24] Interestingly, however, the majority of ''descriptive'' and ''advanced'' data elements were extraneous to predict good or bad outcome in our study. One possible explanation for this finding is that certain details are redundant for dichotomized GOS-E outcomes.…”

Section: Fig 5 (A)contrasting

confidence: 61%

Prognostic Validation of the NINDS Common Data Elements for the Radiologic Reporting of Acute Traumatic Brain Injuries: A CENTER-TBI Study

Vyvere

Rosa

Wilms

et al. 2020

Journal of Neurotrauma

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The aim of this study is to investigate the prognostic value of using the National Institute of Neurological Disorders and Stroke (NINDS) standardized imaging-based pathoanatomic descriptors for the evaluation and reporting of acute traumatic brain injury (TBI) lesions. For a total of 3392 patients (2244 males and 1148 females, median age = 51 years) enrolled in the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study, we extracted 96 Common Data Elements (CDEs) from the structured reports, spanning all three levels of pathoanatomic information (i.e., 20 ''basic,'' 60 ''descriptive,'' and 16 ''advanced'' CDE variables per patient). Six-month clinical outcome scores were dichotomized into favorable (Glasgow Outcome Scale Extended [GOS-E] = 5-8) versus unfavorable (GOS-E = 1-4). Regularized logistic regression models were constructed and compared using the optimism-corrected area under the curve (AUC). An abnormality was reported for the majority of patients (64.51%). In 79.11% of those patients, there was at least one coexisting pathoanatomic lesion or associated finding. An increase in lesion severity, laterality, and volume was associated with more unfavorable outcomes. Compared with the full set of pathoanatomic descriptors (i.e., all three categories of information), reporting ''basic'' CDE information provides at least equal discrimination between patients with favorable versus unfavorable outcome (AUC = 0.8121 vs. 0.8155, respectively). Addition of a selected subset of ''descriptive'' detail to the basic CDEs could improve outcome prediction (AUC = 0.8248). Addition of ''advanced'' or ''emerging/exploratory'' information had minimal prognostic value. Our results show that the NINDS standardized-imaging based pathoanatomic descriptors can be used in large-scale studies and provide important insights into acute TBI lesion patterns. When used in clinical predictive models, they can provide excellent discrimination between patients with favorable and unfavorable 6-month outcomes. If further validated, our findings could support the development of structured and itemized templates in routine clinical radiology.

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“…Nevertheless, several authors are of the view that, early DC is capable of reversing expectant or initially secondary ischemia, or axonal injury due to refractory intracranial hypertension in TBI patients. [ 23 , 28 , 29 ] We advocate that, DC should be performed before irreversible neurological deficit sets in, especially when brain herniation has occurred. The longer the duration of herniation, the more likely it is that patient will develop intracranial hypertension as well as ischemia.…”

Section: Discussionmentioning

confidence: 99%

“…[ 33 ] Lee et al demonstrated that, the prognostic value of MLS should be limited to patients with unilateral mass lesions. [ 28 ]…”

Section: Discussionmentioning

confidence: 99%

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Outcomes of patients undergoing craniotomy and decompressive craniectomy for severe traumatic brain injury with brain herniation

Lan

Richard

et al. 2020

Medicine

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The treatment of severe traumatic brain injury (TBI) with brain herniation is challenging because outcomes are often associated with high mortality and morbidity. Our aim was to identity factors contributing to decompressive craniectomy (DC) and evaluate treatment outcomes in patients with severe TBI with brain herniation. In this retrospective study, we analyzed medical records of severe TBI with brain herniation from May 2009 to December 2013. We reviewed their demographic data, mechanism of injury, Glasgow Coma Scale (GCS) score, pupil status, computed tomography findings, surgical treatment methods, time interval between brain herniation and surgery, as well as outcomes. GCS and pupil status are clinical parameters for detecting increase intracranial pressure while brain parenchyma bulged above the inner plate of the skull during operation indicated brain swelling as well as increased intracranial pressure on which basis the decision to perform DC or craniotomy was determined intraoperatively. One hundred ninety-four patients were included in the study. We performed DC in 143 of the patients while 51 of them we performed craniotomy. There were no statistically significant differences in the age, gender, or injury mechanism between the 2 groups. GCS, pupillary dilation, midline shift, hematoma type and timing of surgery were associated with DC. Nevertheless, logistic regression analysis revealed that hematoma type and timing of surgery were significantly associated with favorable DC outcomes ( P < .001 and P = .023). Subdural hematoma and timing of surgery >1 hour were both identified as risk factors for DC. Six months after TBI, 34.0% of patients exhibited favorable outcomes. Overall mortality rate was 30.4%. Age, GCS, pupil dilation, hematoma type, and timing of surgery were all associated with patient outcomes. Further logistic regression analysis revealed that, lower GCS, bilateral pupil dilation, timing of surgery >1 hour, and advanced age were independent risk factors for poor outcomes ( P = .001, P = .037, P = .028, and P = .001, respectively). Our study revealed that, DC is not mandatory for all TBI patients with brain herniation. Nevertheless, DC decreases mortality rate in severe TBI patients with brain herniation. Subdural hematoma and timing of surgery >1 hour are key indicators for DC. Lower GCS, bilateral pupil dilation, delayed timing of surgery and advance age are indicators of poor outcomes.

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Acute bilateral mass-occupying lesions in non-penetrating traumatic brain injury: a retrospective study

Cited by 5 publications

References 21 publications

Evaluation of the Head Multislice Computed Tomography Scan in Emergency Department

Evaluation of the Head Multislice Computed Tomography Scan in Emergency Department

Prognostic Validation of the NINDS Common Data Elements for the Radiologic Reporting of Acute Traumatic Brain Injuries: A CENTER-TBI Study

Outcomes of patients undergoing craniotomy and decompressive craniectomy for severe traumatic brain injury with brain herniation

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