J Clin Neurol.  2012 Sep;8(3):224-229. 10.3988/jcn.2012.8.3.224.

Prediction of Outcome after Traumatic Brain Injury Using Clinical and Neuroimaging Variables

• Lee SY
• Kim SS
• Kim CH
• Park SW
• Park JH
• Yeo M

• KMID: 2287595
• DOI: http://doi.org/10.3988/jcn.2012.8.3.224

Abstract

BACKGROUND AND PURPOSE
The functional outcome of traumatic brain injury (TBI) varies widely. The aim of this study was to identify the factors predicting outcome following TBI.
METHODS
We prospectively enrolled acute TBI patients, and assessed them clinically and radiologically using brain magnetic resonance imaging (MRI). Functional outcome was measured using the Glasgow Outcome Scale (GOS) at 3 months after TBI. A GOS score of < or =4 was regarded as an unfavorable outcome. We performed multivariate analysis to investigate the association between clinicoradiological variables and outcome.
RESULTS
Forty-two patients completed the clinical evaluation in the acute phase and outcome measurement at 3 months. Motorcycle accident was associated with unfavorable outcome [odds ratio (OR)=38.3, p=0.022]. If the patients were the victims of the accident, they were more likely to have an unfavorable outcome (OR=21.3, p=0.037). All seven patients with a low Glasgow Coma Scale (GCS) score (i.e., < or =8) at 24 or 48 h after TBI were also found to have an unfavorable outcome. The presence of diffuse axonal injury (DAI) was a significant predicting factor of an unfavorable outcome (OR=8.48, p=0.042).
CONCLUSIONS
Motorcycle accident, being an accident victim, and a lower GCS score at 24 hours or more after the accident were found to be unfavorable prognostic variables. DAI was the only radiologic variable predicting an unfavorable outcome. Thus, it is important to identify DAI by applying MRI in the acute phase.

Keyword

traumatic brain injury; outcome; magnetic resonance imaging

MeSH Terms

Brain
Brain Injuries
Diffuse Axonal Injury
Glasgow Coma Scale
Glasgow Outcome Scale
Humans
Magnetic Resonance Imaging
Motorcycles
Multivariate Analysis
Neuroimaging
Prospective Studies

Reference

1. Bruns J Jr, Hauser WA. The epidemiology of traumatic brain injury: a review. Epilepsia. 2003. 44:Suppl 10. 2–10.

2. Lagares A, Ramos A, Pérez-Nuñez A, Ballenilla F, Alday R, Gómez PA, et al. The role of MR imaging in assessing prognosis after severe and moderate head injury. Acta Neurochir (Wien). 2009. 151:341–356.

3. MRC CRASH, Perel P, Arango M, Clayton T, Edwards P, Komolafe E, et al. Predicting outcome after traumatic brain injury: practical prognostic models based on large cohort of international patients. BMJ. 2008. 336:425–429.

4. Murray GD, Butcher I, McHugh GS, Lu J, Mushkudiani NA, Maas AI, et al. Multivariable prognostic analysis in traumatic brain injury: results from the IMPACT study. J Neurotrauma. 2007. 24:329–337.

5. Di Stefano G, Bachevalier J, Levin HS, Song JX, Scheibel RS, Fletcher JM. Volume of focal brain lesions and hippocampal formation in relation to memory function after closed head injury in children. J Neurol Neurosurg Psychiatry. 2000. 69:210–216.

6. Weiss N, Galanaud D, Carpentier A, Naccache L, Puybasset L. Clinical review: Prognostic value of magnetic resonance imaging in acute brain injury and coma. Crit Care. 2007. 11:230.

7. Gentry LR, Godersky JC, Thompson B, Dunn VD. Prospective comparative study of intermediate-field MR and CT in the evaluation of closed head trauma. AJR Am J Roentgenol. 1988. 150:673–682.

8. Weiss N, Galanaud D, Carpentier A, Tezenas de, Naccache L, Coriat P, et al. A combined clinical and MRI approach for outcome assessment of traumatic head injured comatose patients. J Neurol. 2008. 255:217–223.

9. Skandsen T, Kvistad KA, Solheim O, Lydersen S, Strand IH, Vik A. Prognostic value of magnetic resonance imaging in moderate and severe head injury: a prospective study of early MRI findings and one-year outcome. J Neurotrauma. 2011. 28:691–699.

10. Huisman TA. Diffusion-weighted imaging: basic concepts and application in cerebral stroke and head trauma. Eur Radiol. 2003. 13:2283–2297.

11. Gentry LR. Imaging of closed head injury. Radiology. 1994. 191:1–17.

12. Ezaki Y, Tsutsumi K, Morikawa M, Nagata I. Role of diffusion-weighted magnetic resonance imaging in diffuse axonal injury. Acta Radiol. 2006. 47:733–740.

13. Parizel PM, Ozsarlak , Van Goethem JW, van den Hauwe L, Dillen C, Verlooy J, et al. Imaging findings in diffuse axonal injury after closed head trauma. Eur Radiol. 1998. 8:960–965.

14. Skandsen T, Kvistad KA, Solheim O, Strand IH, Folvik M, Vik A. Prevalence and impact of diffuse axonal injury in patients with moderate and severe head injury: a cohort study of early magnetic resonance imaging findings and 1-year outcome. J Neurosurg. 2010. 113:556–563.

15. Fisher CM, Kistler JP, Davis JM. Relation of cerebral vasospasm to subarachnoid hemorrhage visualized by computerized tomographic scanning. Neurosurgery. 1980. 6:1–9.

16. Shuaeib FM, Hamouda AMS, Umar RSR, Hamdan MM, Hashmi MSJ. Motorcycle helmet. Part I. Biomechanics and computational issues. J Mater Process Technol. 2002. 123:406–421.

17. Butcher I, McHugh GS, Lu J, Steyerberg EW, Hernández AV, Mushkudiani N, et al. Prognostic value of cause of injury in traumatic brain injury: results from the IMPACT study. J Neurotrauma. 2007. 24:281–286.

18. Maas AI, Stocchetti N, Bullock R. Moderate and severe traumatic brain injury in adults. Lancet Neurol. 2008. 7:728–741.

19. Gentry LR, Godersky JC, Thompson B. MR imaging of head trauma: review of the distribution and radiopathologic features of traumatic lesions. AJR Am J Roentgenol. 1988. 150:663–672.

20. Zink BJ. Traumatic brain injury outcome: concepts for emergency care. Ann Emerg Med. 2001. 37:318–332.

21. Steyerberg EW, Mushkudiani N, Perel P, Butcher I, Lu J, McHugh GS, et al. Predicting outcome after traumatic brain injury: development and international validation of prognostic scores based on admission characteristics. PLoS Med. 2008. 5:e165.

22. Carroll LJ, Cassidy JD, Peloso PM, Borg J, von Holst H, Holm L, et al. Prognosis for mild traumatic brain injury: results of the WHO Collaborating Centre Task Force on Mild Traumatic Brain Injury. J Rehabil Med. 2004. 43 Suppl. 84–105.