@article{ref1,
title="Pathological computed tomography features associated with adverse outcomes after mild traumatic brain injury: a TRACK-TBI study with external validation in CENTER-TBI",
journal="JAMA neurology",
year="2021",
author="Yuh, Esther L. and Jain, Sonia and Sun, Xiaoying and Pisica, Dana and Harris, Mark H. and Taylor, Sabrina R. and Markowitz, Amy J. and Mukherjee, Pratik and Verheyden, Jan and Giacino, Joseph T. and Levin, Harvey S. and McCrea, Michael and Stein, Murray B. and Temkin, Nancy R. and Diaz-Arrastia, Ramon and Robertson, Claudia S. and Lingsma, Hester F. and Okonkwo, David O. and Maas, Andrew I. R. and Manley, Geoffrey T. and Adeoye, Opeolu and Badjatia, Neeraj and Boase, Kim and Bodien, Yelena and Corrigan, John D. and Crawford, Karen and Dikmen, Sureyya and Duhaime, Ann-Christine and Ellenbogen, Richard and Feeser, V. Ramana and Ferguson, Adam R. and Foreman, Brandon and Gardner, Raquel and Gaudette, Étienne and González, Luis and Gopinath, Shankar and Gullapalli, Rao and Hemphill, J. Claude and Hotz, Gillian and Keene, C. Dirk and Kramer, Joel and Kreitzer, Natalie and Lindsell, Chris and Machamer, Joan and Madden, Christopher and Martin, Alastair and McAllister, Thomas and Merchant, Randall and Nelson, Lindsay and Ngwenya, Laura B. and Noel, Florence and Nolan, Amber and Palacios, Eva and Perl, Daniel and Rabinowitz, Miri and Rosand, Jonathan and Sander, Angelle and Satris, Gabriella and Schnyer, David and Seabury, Seth and Toga, Arthur and Valadka, Alex and Vassar, Mary and Zafonte, Ross",
volume="ePub",
number="ePub",
pages="ePub-ePub",
abstract="IMPORTANCE: A head computed tomography (CT) with positive results for acute intracranial hemorrhage is the gold-standard diagnostic biomarker for acute traumatic brain injury (TBI). In moderate to severe TBI (Glasgow Coma Scale [GCS] scores 3-12), some CT features have been shown to be associated with outcomes. In mild TBI (mTBI; GCS scores 13-15), distribution and co-occurrence of pathological CT features and their prognostic importance are not well understood. <br><br>OBJECTIVE: To identify pathological CT features associated with adverse outcomes after mTBI. DESIGN, SETTING, AND PARTICIPANTS: The longitudinal, observational Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) study enrolled patients with TBI, including those 17 years and older with GCS scores of 13 to 15 who presented to emergency departments at 18 US level 1 trauma centers between February 26, 2014, and August 8, 2018, and underwent head CT imaging within 24 hours of TBI. Evaluations of CT imaging used TBI Common Data Elements. Glasgow Outcome Scale-Extended (GOSE) scores were assessed at 2 weeks and 3, 6, and 12 months postinjury. External validation of results was performed via the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study. Data analyses were completed from February 2020 to February 2021. EXPOSURES: Acute nonpenetrating head trauma. MAIN OUTCOMES AND MEASURES: Frequency, co-occurrence, and clustering of CT features; incomplete recovery (GOSE scores <8 vs 8); and an unfavorable outcome (GOSE scores <5 vs ≥5) at 2 weeks and 3, 6, and 12 months. <br><br>RESULTS: In 1935 patients with mTBI (mean [SD] age, 41.5 [17.6] years; 1286 men [66.5%]) in the TRACK-TBI cohort and 2594 patients with mTBI (mean [SD] age, 51.8 [20.3] years; 1658 men [63.9%]) in an external validation cohort, hierarchical cluster analysis identified 3 major clusters of CT features: contusion, subarachnoid hemorrhage, and/or subdural hematoma; intraventricular and/or petechial hemorrhage; and epidural hematoma. Contusion, subarachnoid hemorrhage, and/or subdural hematoma features were associated with incomplete recovery (odds ratios [ORs] for GOSE scores <8 at 1 year: TRACK-TBI, 1.80 [95% CI, 1.39-2.33]; CENTER-TBI, 2.73 [95% CI, 2.18-3.41]) and greater degrees of unfavorable outcomes (ORs for GOSE scores <5 at 1 year: TRACK-TBI, 3.23 [95% CI, 1.59-6.58]; CENTER-TBI, 1.68 [95% CI, 1.13-2.49]) out to 12 months after injury, but epidural hematoma was not. Intraventricular and/or petechial hemorrhage was associated with greater degrees of unfavorable outcomes up to 12 months after injury (eg, OR for GOSE scores <5 at 1 year in TRACK-TBI: 3.47 [95% CI, 1.66-7.26]). Some CT features were more strongly associated with outcomes than previously validated variables (eg, ORs for GOSE scores <5 at 1 year in TRACK-TBI: neuropsychiatric history, 1.43 [95% CI.98-2.10] vs contusion, subarachnoid hemorrhage, and/or subdural hematoma, 3.23 [95% CI 1.59-6.58]). <br><br>FINDINGS were externally validated in 2594 patients with mTBI enrolled in the CENTER-TBI study. <br><br>CONCLUSIONS AND RELEVANCE: In this study, pathological CT features carried different prognostic implications after mTBI to 1 year postinjury. Some patterns of injury were associated with worse outcomes than others. These results support that patients with mTBI and these CT features need TBI-specific education and systematic follow-up.<p /> <p>Language: en</p>",
language="en",
issn="2168-6149",
doi="10.1001/jamaneurol.2021.2120",
url="http://dx.doi.org/10.1001/jamaneurol.2021.2120"
}