Cino Bendinelli1, Shannon Cooper1, Tiffany Evans2, Andrew Bivard3, Dianne Pacey4, Mark Parson3, Zsolt J Balogh5. 1. Department of Traumatology, John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia. 2. Clinical Research Design, Information Technology and Statistical Support, Hunter Medical Research Institute, Newcastle, NSW, Australia. 3. Department of Neurology, John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia. 4. Department of Rehabilitation, John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia. 5. Department of Traumatology, John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia. zsolt.balogh@hnehealth.nsw.gov.au.
Abstract
BACKGROUND: In patients with severe traumatic brain injury (TBI), early CT perfusion (CTP) provides additional information beyond the non-contrast CT (NCCT) and may alter clinical management. We hypothesized that this information may prognosticate functional outcome. METHODS: Five-year prospective observational study was performed in a level-1 trauma centre on consecutive severe TBI patients. CTP (obtained in conjunction with first routine NCCT) was interpreted as: abnormal, area of altered perfusion more extensive than on NCCT, and the presence of ischaemia. Six months Glasgow Outcome Scale-Extended of four or less was considered an unfavourable outcome. Logistic regression analysis of CTP findings and core variables [preintubation Glasgow Coma Scale (GCS), Rotterdam score, base deficit, age] was conducted using Bayesian model averaging to identify the best predicting model for unfavourable outcome. RESULTS: Fifty patients were investigated with CTP (one excluded for the absence of TBI) [male: 80%, median age: 35 (23-55), prehospital intubation: 7 (14.2%); median GCS: 5 (3-7); median injury severity score: 29 (20-36); median head and neck abbreviated injury scale: 4 (4-5); median days in ICU: 10 (5-15)]. Thirty (50.8%) patients had an unfavourable outcome. GCS was a moderate predictor of unfavourable outcome (AUC = 0.74), while CTP variables showed greater predictive ability (AUC for abnormal CTP = 0.92; AUC for area of altered perfusion more extensive than NCCT = 0.83; AUC for the presence of ischaemia = 0.81). CONCLUSION: Following severe TBI, CTP performed at the time of the first follow-up NCCT, is a non-invasive and extremely valuable tool for early outcome prediction. The potential impact on management and its cost effectiveness deserves to be evaluated in large-scale studies. LEVEL OF EVIDENCE III: Prospective study.
BACKGROUND: In patients with severe traumatic brain injury (TBI), early CT perfusion (CTP) provides additional information beyond the non-contrast CT (NCCT) and may alter clinical management. We hypothesized that this information may prognosticate functional outcome. METHODS: Five-year prospective observational study was performed in a level-1 trauma centre on consecutive severe TBIpatients. CTP (obtained in conjunction with first routine NCCT) was interpreted as: abnormal, area of altered perfusion more extensive than on NCCT, and the presence of ischaemia. Six months Glasgow Outcome Scale-Extended of four or less was considered an unfavourable outcome. Logistic regression analysis of CTP findings and core variables [preintubation Glasgow Coma Scale (GCS), Rotterdam score, base deficit, age] was conducted using Bayesian model averaging to identify the best predicting model for unfavourable outcome. RESULTS: Fifty patients were investigated with CTP (one excluded for the absence of TBI) [male: 80%, median age: 35 (23-55), prehospital intubation: 7 (14.2%); median GCS: 5 (3-7); median injury severity score: 29 (20-36); median head and neck abbreviated injury scale: 4 (4-5); median days in ICU: 10 (5-15)]. Thirty (50.8%) patients had an unfavourable outcome. GCS was a moderate predictor of unfavourable outcome (AUC = 0.74), while CTP variables showed greater predictive ability (AUC for abnormal CTP = 0.92; AUC for area of altered perfusion more extensive than NCCT = 0.83; AUC for the presence of ischaemia = 0.81). CONCLUSION: Following severe TBI, CTP performed at the time of the first follow-up NCCT, is a non-invasive and extremely valuable tool for early outcome prediction. The potential impact on management and its cost effectiveness deserves to be evaluated in large-scale studies. LEVEL OF EVIDENCE III: Prospective study.
Entities:
Keywords:
Glasgow Coma Scale; Injury Severity Score; Severe Traumatic Brain Injury; Traumatic Brain Injury; Unfavourable Outcome
Authors: Kathryn E Saatman; Ann-Christine Duhaime; Ross Bullock; Andrew I R Maas; Alex Valadka; Geoffrey T Manley Journal: J Neurotrauma Date: 2008-07 Impact factor: 5.269
Authors: John A Myburgh; D James Cooper; Simon R Finfer; Balasubramanian Venkatesh; Daryl Jones; Alisa Higgins; Nicole Bishop; Tracey Higlett Journal: J Trauma Date: 2008-04
Authors: Stefano Signoretti; Anthony Marmarou; Gunes A Aygok; Panos P Fatouros; Gina Portella; Ross M Bullock Journal: J Neurosurg Date: 2008-01 Impact factor: 5.115
Authors: Andrew Bivard; Christopher Levi; Venkatesh Krishnamurthy; Patrick McElduff; Ferdi Miteff; Neil J Spratt; Grant Bateman; Geoffrey Donnan; Stephen Davis; Mark Parsons Journal: Brain Date: 2015-03-25 Impact factor: 13.501
Authors: Marek Majdan; Hester F Lingsma; Daan Nieboer; Walter Mauritz; Martin Rusnak; Ewout W Steyerberg Journal: Scand J Trauma Resusc Emerg Med Date: 2014-11-19 Impact factor: 2.953
Authors: Lisa A van der Kleij; Jill B De Vis; Matthew C Restivo; L Christine Turtzo; Jeroen Hendrikse; Lawrence L Latour Journal: J Neurotrauma Date: 2019-12-05 Impact factor: 5.269