Prognostic Value of Computerized Tomography Scan Characteristics in Traumatic Brain Injury: Results from The IMPACT Study

Abstract

Computerized tomography (CT) scanning provides an objective assessment of the structural damage to the brain following traumatic brain injury (TBI). We aimed to describe and quantify the relationship between CT characteristics and 6-month outcome, assessed by the Glasgow Outcome Scale (GOS). Individual patient data from the IMPACT database were available on CT classification (N = 5209), status of basal cisterns ( N = 3861), shift ( N = 4698), traumatic subarachnoid hemorrhage (tSAH) ( N = 7407), and intracranial lesions ( N = 7613). We used binary logistic and proportional odds regression for prognostic analyses. The CT classification was strongly related to outcome, with worst outcome for patients with diffuse injuries in CT class III (swelling; OR 2.50; CI 2.09-3.0) or CT class IV (shift; OR 3.03; CI 2.12-4.35). The prognosis in patients with mass lesions was better for patients with an epidural hematoma (OR 0.64; CI 0.56-0.72) and poorer for an acute subdural hematoma (OR 2.14; CI 1.87-2.45). Partial obliteration of the basal cisterns (OR 2.45; CI 1.88-3.20), tSAH (OR 2.64; CI 2.42-2.89), or midline shift (1-5 mm-OR 1.36; CI 1.09-1.68); >5 mm-OR 2.20; CI 1.64-2.96) were strongly related to poorer outcome. Discrepancies were found between the scoring of basal cisterns/shift and the CT classification, indicating observer variation. These were less marked in studies that had used a central review process. Multivariable analysis indicated that individual CT characteristics added substantially to the prognostic value of the CT classification alone. We conclude that both the CT classification and individual CT characteristics are important predictors of outcome in TBI. For clinical trials, a central review process is advocated to minimize observer variability in CT assessment.

Assessment of White Matter Injury and Outcome in Severe Brain Trauma. A Prospective Multicenter Cohort

“…15 The sensitivity of the classifier was calculated for 95% specificity for unfavorable outcome prediction. In addition, we computed net reclassification improvement and integrated discrimination improvement indices to compare our DTI score with IMPACT 16 by using R Software. § § § § § Confidence interval ‡ ‡ ‡ ‡ ‡ http://www.csie.ntu.edu.tw/~cjlin/libsvm/.…”

“…The prognostic value of cranial CT scan is also limited. 16 The IMPACT score, based on a multivariate model combining clinical, biochemical, and CT scan characteristics, has been developed from a dataset of more than 9,000 patients and has been validated externally against similar large patient populations. 17 However, this score does not have the discriminative power needed for clinical decision-making in individual patients.…”

Causal Role of Apoptosis-Inducing Factor for Neuronal Cell Death Following Traumatic Brain Injury

“…1 Among the various pathologies associated with TBI, gray and white matter contusions are the most frequent focal abnormalities associated with high mortality and unfavorable functional outcome. 2 The pathophysiology of cerebral contusions is characterized by complex regional and temporal changes of cerebral blood flow and metabolism, 3,4 disruption of the blood brain barrier resulting in brain edema formation, 5 and cell death signaling, 6 -8 finally leading to progressive neuronal cell death in pericontusional tissue (ie, the traumatic penumbra). 9 The macroscopic manifestation of pericontusional cell death is a delayed increase of contusion volume over time, 10 a finding termed "secondary contusion expansion," and recently characterized experimentally in detail.…”

Homocystein Levels in Migraine Patients

“…Outcome prediction is not an easy task to achieve after HI, because of complexity of affecting the factors. We described two new predicting models with well described parameter by recent studies for affecting the prognosis of head injured patient (1,(3)(4)(5)(6)(7)(8)(9)(10)(11)(12). In differently, the most of these parameters used in our models were simplified present or absent for easy using.…”

“…(1,(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14). In the literature, more than one hundred recent studies, most of them from developed countries, were designed for predicting the prognosis after HI (15).…”