Predicting Outcome after Pediatric Traumatic Brain Injury by Early Magnetic Resonance Imaging Lesion Location and Volume

Smitherman, Emily A.; Hernández, Ana María; Stavinoha, Peter L.; Huang, Rong; Kernie, Steven G.; Diaz‐Arrastia, Ramon; Miles, Darryl K.

doi:10.1089/neu.2014.3801

Cited by 41 publications

(28 citation statements)

References 79 publications

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“…The Magnetic Resonance Imaging (MRI) Fluidattenuated inversion recovery (FLAIR) hyperintense lesions in mentioned zones were correlated with GOS. The study reported that Patients with lesion in all three zones were 4.4 times at the risk of unfavourable as compared to lesions only in zone A or both in zone A & B (10). In the present study only cortical areas are evaluated based on standard anatomical demarcation that is frontal, parietal, temporal and occipital lobes.…”

Section: Location Of Abnormal Ct Signsmentioning

confidence: 98%

“…The scoring systems are not without limitations. Prediction of TBI outcome may be better with individual or combination of location and/or laterality of abnormal CT signs (4,8,9,10).…”

Section: Location Of Abnormal Ct Signsmentioning

confidence: 99%

“…The locations of abnormal imaging characteristic either focal or diffuse are also important in predicting outcome (10). But localization of imaging characteristic in specific brain lobes (either single or combination) may also be useful in outcome prediction, because brain lesions in different anatomical areas are heterogeneous in manifestation (10).…”

Section: Location Of Abnormal Ct Signsmentioning

confidence: 99%

“…But localization of imaging characteristic in specific brain lobes (either single or combination) may also be useful in outcome prediction, because brain lesions in different anatomical areas are heterogeneous in manifestation (10). A study on paediatric TBI predicted outcome based on location of brain lesions.…”

Section: Location Of Abnormal Ct Signsmentioning

confidence: 99%

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Commonly available CT characteristics and prediction of outcome in traumatic brain injury patients

Kumar¹,

Reddy²,

Pratyusha³

et al. 2017

Romanian Neurosurgery

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Abstract:Background: Acute Computerized Tomography (CT) characteristics are used widely and most accepted for prediction of outcome among Traumatic Brain Injury (TBI). The commonly available and simple combinations of existing and unexplored CT parameters may be more useful in prediction of outcome. The present study explores commonly available CT characteristics by possible combinations based on anatomical basics. Methods: Abnormal CT sign was considered with any cranial lesion. Based on anatomical locations of cortical lobes, nine possibilities were made that include individual and combinations of mentioned lobes. The laterality was either right or left or bilateral. The outcome was favourable or unfavourable based on discharge Glasgow Outcome Scale (GOS). Binary logistic regression was used to predict outcome.Brought to you by | MIT Libraries Authenticated Download Date | 5/13/18 4:07 AM | Kumar et al -Commonly available CT characteristicsResults: 452 patients were recruited in the present study. There was significant risk of unfavourable outcome among patients with location of Sub Dural Haemorrhage (SDH) in Parietal + Temporal region (OR=10,p<0.001); Cerebral Contusion in Temporal region (OR=3,p=0.03), Frontal + Temporal region(OR=16,P=0.001), Frontal + Parietal + Temporal region (OR=18.7,p<0.001). Patients with four abnormal CT signs had worst outcome. Presence of SDH on right side (OR=4.5,p<0.001) and bilateral Cerebral Contusion (OR=4.5,p=0.003) was at the risk of unfavourable outcome. Conclusion: The present study based on anatomical classification has shown that location and laterality of lesion can significantly predict TBI outcome.

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Section: Location Of Abnormal Ct Signsmentioning

confidence: 98%

“…The scoring systems are not without limitations. Prediction of TBI outcome may be better with individual or combination of location and/or laterality of abnormal CT signs (4,8,9,10).…”

Section: Location Of Abnormal Ct Signsmentioning

confidence: 99%

Section: Location Of Abnormal Ct Signsmentioning

confidence: 99%

Section: Location Of Abnormal Ct Signsmentioning

confidence: 99%

See 2 more Smart Citations

Commonly available CT characteristics and prediction of outcome in traumatic brain injury patients

Kumar¹,

Reddy²,

Pratyusha³

et al. 2017

Romanian Neurosurgery

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show abstract

“…13,19 However, MRI takes longer to perform than CT, requires patients to hold still for an extended time, and often requires sedation, all of which limits its use in pediatric patients. QuickBrain MRI (qbMRI) includes rapid acquisition of axial, sagittal, and coronal T2-weighted fast spin echo images.…”

mentioning

confidence: 99%

QuickBrain MRI for the detection of acute pediatric traumatic brain injury

Sheridan

Newgard

Selden

et al. 2017

PED

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OBJECTIVE The current gold-standard imaging modality for pediatric traumatic brain injury (TBI) is CT, but it confers risks associated with ionizing radiation. QuickBrain MRI (qbMRI) is a rapid brain MRI protocol that has been studied in the setting of hydrocephalus, but its ability to detect traumatic injuries is unknown. METHODS The authors performed a retrospective cohort study of pediatric patients with TBI who were undergoing evaluation at a single Level I trauma center between February 2010 and December 2013. Patients who underwent CT imaging of the head and qbMRI during their acute hospitalization were included. Images were reviewed independently by 2 neuroradiology fellows blinded to patient identifiers. Image review consisted of identifying traumatic mass lesions and their intracranial compartment and the presence or absence of midline shift. CT imaging was used as the reference against which qbMRI was measured. RESULTS A total of 54 patients met the inclusion criteria; the median patient age was 3.24 years, 65% were male, and 74% were noted to have a Glasgow Coma Scale score of 14 or greater. The sensitivity and specificity of qbMRI to detect any lesion were 85% (95% CI 73%–93%) and 100% (95% CI 61%–100%), respectively; the sensitivity increased to 100% (95% CI 89%–100%) for clinically important TBIs as previously defined. The mean interval between CT and qbMRI was 27.5 hours, and approximately half of the images were obtained within 12 hours. CONCLUSIONS In this retrospective pilot study, qbMRI demonstrated reasonable sensitivity and specificity for detecting a lesion or injury seen with neuroimaging (radiographic TBI) and clinically important acute pediatric TBI.

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MRI and Clinical Variables for Prediction of Outcomes After Pediatric Severe Traumatic Brain Injury

Ferrazzano,

Rebsamen,

Field

et al. 2024

JAMA Netw Open

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ImportanceTraumatic brain injury (TBI) is a leading cause of death and disability in children, and predicting functional outcome after TBI is challenging. Magnetic resonance imaging (MRI) is frequently conducted after severe TBI; however, the predictive value of MRI remains uncertain.ObjectivesTo identify early MRI measures that predict long-term outcome after severe TBI in children and to assess the added predictive value of MRI measures over well-validated clinical predictors.Design, Setting, and ParticipantsThis preplanned prognostic study used data from the Approaches and Decisions in Acute Pediatric TBI (ADAPT) prospective observational comparative effectiveness study. The ADAPT study enrolled 1000 consecutive children (aged &lt;18 years) with severe TBI between February 1, 2014, and September 30, 2017. Participants had a Glasgow Coma Scale (GCS) score of 8 or less and received intracranial pressure monitoring. Magnetic resonance imaging scans performed as part of standard clinical care within 30 days of injury were collected at 24 participating sites in the US, UK, and Australia. Summary imaging measures were correlated with the Glasgow Outcome Scale–Extended for Pediatrics (GOSE-Peds), and the predictive value of MRI measures was compared with the International Mission for Prognosis and Analysis of Clinical Trials in TBI (IMPACT) core clinical predictors. Data collection, image analysis, and data analyses were completed in July 2023.ExposuresPediatric severe TBI with an MRI scan performed as part of clinical care.Main Outcomes and MeasuresAll measures were selected a priori. Magnetic resonance imaging measures included contusion, ischemia, diffuse axonal injury, intracerebral hemorrhage, and brainstem injury. Clinical predictors included the IMPACT core measures (GCS motor score and pupil reactivity). All models adjusted for age and sex. Outcome measures included the GOSE-Peds score obtained at 3, 6, and 12 months after injury.ResultsThis study included 233 children with severe TBI who were enrolled at participating sites and had an MRI scan and preselected clinical predictors available. Their median age was 6.9 (IQR, 3.0-13.3) years, and more than half of participants (134 [57.5%]) were male. In a multivariable model including MRI measures and IMPACT core clinical variables, contusion volume (odds ratio [OR], 1.13; 95% CI, 1.02-1.26), brain ischemia (OR, 2.11; 95% CI, 1.58-2.81), brainstem lesions (OR, 5.40; 95% CI, 1.90-15.35), and pupil reactivity were each independently associated with GOSE-Peds score. Adding MRI measures to the IMPACT clinical predictors significantly improved model fit and discrimination between favorable and unfavorable outcomes compared with IMPACT predictors alone (area under the receiver operating characteristic curve, 0.77; 95% CI, 0.72-0.85 vs 0.67; 95% CI, 0.61-0.76 for GOSE-Peds score &gt;3 at 6 months after injury).Conclusions and RelevanceIn this prognostic study of children with severe TBI, the addition of MRI measures significantly improved outcome prediction over well-established and validated clinical predictors. Magnetic resonance imaging should be considered in children with severe TBI to inform prognosis and may also promote stratification of patients in future clinical trials.

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Predicting Outcome after Pediatric Traumatic Brain Injury by Early Magnetic Resonance Imaging Lesion Location and Volume

Cited by 41 publications

References 79 publications

Commonly available CT characteristics and prediction of outcome in traumatic brain injury patients

Commonly available CT characteristics and prediction of outcome in traumatic brain injury patients

QuickBrain MRI for the detection of acute pediatric traumatic brain injury

MRI and Clinical Variables for Prediction of Outcomes After Pediatric Severe Traumatic Brain Injury

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