Prediction of Outcome after Traumatic Brain Injury Using Clinical and Neuroimaging Variables
2
조회
0
다운로드
2
인용
0
참고문헌
키워드
초록
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 =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., =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 24hours 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
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 =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., =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 24hours 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
참고문헌 (22)
- Bruns J Jr, "The epidemiology of traumatic brain injury: a review", Epilepsia, 44(10), pp.2~10 (2003)
- Lagares A, "The role of MR imaging in assessing prognosis after severe and moderate head injury", Acta Neurochir (Wien), 151, pp.341~356 (2009)
- Perel P, "Predicting outcome after traumatic brain injury: practical prognostic models based on large cohort of international patients", BMJ, 336, pp.425~429 (2008)
- Murray GD, "Multivariable prognostic analysis in traumatic brain injury: results from the IMPACT study", J Neurotrauma, 24, pp.329~337 (2007)
- Di Stefano G, "Volume of focal brain lesions and hippocampal formation in relation to memory function after closed head injury in children", J Neurol Neurosurg Psychiatry, 69, pp.210~216 (2000)
- Weiss N, "Clinical review: Prognostic value of magnetic resonance imaging in acute brain injury and coma", Crit Care, 11, pp.230~ (2007)
- Gentry LR, "Prospective comparative study of intermediate-field MR and CT in the evaluation of closed head trauma", AJR Am J Roentgenol, 150, pp.673~682 (1988)
- Weiss N, "A combined clinical and MRI approach for outcome assessment of traumatic head injured comatose patients", J Neurol, 255, pp.217~223 (2008)
- Skandsen T, "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, 28, pp.691~699 (2011)
- Huisman TA, "Diffusion-weighted imaging: basic concepts and application in cerebral stroke and head trauma", Eur Radiol, 13, pp.2283~2297 (2003)
- Gentry LR., "Imaging of closed head injury", Radiology, 191, pp.1~17 (1994)
- Ezaki Y, "Role of diffusion-weighted magnetic resonance imaging in diffuse axonal injury", Acta Radiol, 47, pp.733~740 (2006)
- Parizel PM, "Imaging findings in diffuse axonal injury after closed head trauma", Eur Radiol, 8, pp.960~965 (1998)
- Skandsen T, "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, 113, pp.556~563 (2010)
- Fisher CM, "Relation of cerebral vasospasm to subarachnoid hemorrhage visualized by computerized tomographic scanning", Neurosurgery, 6, pp.1~9 (1980)
- Shuaeib FM, "Motorcycle helmet. Part I. Biomechanics and computational is sues", J Mater Process Technol, 123, pp.406~421 (2002)
- Butcher I, "Prognostic value of cause of injury in traumatic brain injury: results from the IMPACT study", J Neurotrauma, 24, pp.281~286 (2007)
- Maas AI, "Moderate and severe traumatic brain injury in adults", Lancet Neurol, 7, pp.728~741 (2008)
- Gentry LR, "MR imaging of head trauma: review of the distribution and radiopathologic features of traumatic lesions", AJR Am J Roentgenol, 150, pp.663~672 (1988)
- Zink BJ, "Traumatic brain injury outcome: concepts for emergency care", Ann Emerg Med, 37, pp.318~332 (2001)
- Steyerberg EW, "Predicting outcome after traumatic brain injury: development and international validation of prognostic scores based on admission characteristics", PLoS Med, 5, pp.e165~ (2008)
- Carroll LJ, "Prognosis for mild traumatic brain injury: results of the WHO Collaborating Centre Task Force on Mild Traumatic Brain Injury", J Rehabil Med, (43 Suppl), pp.84~105 (2004)