Citation

Majercik S, Bledsoe J, Ryser DK, Hopkins RO, Fair JE, Frost RB, MacDonald J, Barrett R, Horn SD, Pisani D, Bigler ED, Gardner S, Stevens M, Larson MJ. J. Trauma Acute Care Surg. 2016; 82(1): 80-92.

Affiliation

Division of Trauma Services and Surgical Critical Care, Intermountain Medical Center, Murray, UT, USA Sarah.Majercik@imail.org Department of Emergency Medicine, Intermountain Medical Center, Murray, UT, USA Joseph.Bledsoe@imail.org Department of Rehabilitation Medicine, Intermountain Medical Center, Murray, UT David.ryser@imail.org Department of Medicine, Pulmonary and Critical Care Division, Intermountain Medical Center, Murray, Utah mona.hopkins@imail.org and Center for Humanizing Critical Care, Intermountain Medicine, Murray, Utah and Department of Psychology and Neuroscience Center, Brigham Young University, Provo, UT Department of Psychology, Brigham Young University, Provo, UT jfairmail@gmail.com Department of Psychiatry University of New Mexico College of Medicine, Albuquerque, NM rbfrost@salud.unm.edu and Department of Psychology, Brigham Young University, Provo, UT Department of Neurosurgery, University of Utah, Salt Lake City, UT and Intermountain Medical Center, Murray, UT vasospaz@aol.com Institute for Clinical Outcomes Research, Salt Lake City, UT ryanscottbarrett@gmail.com Institute for Clinical Outcomes Research, Salt Lake City, UT Susan.horn@isisicor.org Department of Radiology, Intermountain Medical Center David.pisani@mtnmedical.com Department of Psychology and Neuroscience Center, Brigham Young University, Provo, UT Erin_Bigler@byu.edu Division of Trauma Services, Intermountain Medical Center, Murray, UT, USA Scott.Gardner@gmail.com Division of Trauma Services and Surgical Critical Care, Intermountain Medical Center, Murray, UT, USA Mark.stevens@imail.org Department of Psychology and Neuroscience Center, Brigham Young University, Provo, UT michael_larson@byu.edu.

Copyright

(Copyright © 2016, Lippincott Williams and Wilkins)

DOI

10.1097/TA.0000000000001263

PMID

27805992

Abstract

INTRODUCTION: Day-of-injury (DOI) brain lesion volumes in traumatic brain injury (TBI) patients are rarely used to predict long-term outcomes in the acute setting. The purpose of this study was to investigate the relationship between acute brain injury lesion volume and rehabilitation outcomes in patients with TBI at a Level One Trauma Center.

METHODS: Patients with TBI who were admitted to our rehabilitation unit after the acute care trauma service from February 2009-July 2011 were eligible for the study. Demographic data and outcome variables including cognitive and motor FIM scores, length of stay (LOS) in the rehabilitation unit, and ability to return to home were obtained. DOI quantitative injury lesion volumes and degree of midline shift were obtained from day-of-injury (DOI) brain computed tomography (CT) scans. A multiple step-wise regression model including 13 independent variables was created. This model was used to predict post-rehabilitation outcomes, including FIM scores and ability to return to home. P<0.05 was considered significant.

RESULTS: 96 patients were enrolled in the study. Mean age was 43±21 years, admission Glasgow Coma Score 8.4±4.8, Injury Severity Score 24.7±9.9, and head Abbreviated Injury Scale score 3.73±0.97. Acute hospital length of stay (LOS) was 12.3±8.9 days and rehabilitation LOS was 15.9±9.3 days. Day-of-injury TBI lesion volumes were inversely associated with cognitive FIM scores at rehabilitation admission (p=0.004) and discharge (p=0.004) and inversely associated with ability to be discharged to home after rehabilitation (p=0.006).

CONCLUSION: In a cohort of patients with moderate to severe TBI requiring a rehabilitation unit stay after the acute care hospital stay, DOI brain injury lesion volumes are associated with worse cognitive FIM scores at the time of rehabilitation admission and discharge. Smaller injury volumes were associated with eventual discharge to home. Volumetric neuroimaging in the acute injury phase may improve surgeons' ultimate outcome predictions in TBI patients.Level of Evidence/Study TypeLevel V, case series, Prognostic/Epidemiological.

Language: en